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General NPI Number Information
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NPI Number | 1013155191
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Entity Type | Organization
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Legal Business Name | THERESE M. BOGS, D.D.S., LTD.
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Dates
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Enumeration Date | 01/28/2009
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 5601 W MONEE MANHATTAN RD STE 117
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City | MONEE
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State | IL
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Zip | 60449-8866
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Country | US
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Telephone | 708-534-9700
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Fax | 708-534-9228
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Provider Business Mailing Address
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Address Line | 26634 S WINFIELD RD
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City | MONEE
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State | IL
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Zip | 60449-9220
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Country | US
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Telephone | 708-534-7818
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THERESE MARIE BOGS
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Credential | DDS
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Telephone | 708-534-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019-022073
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License Number State | IL
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