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General NPI Number Information
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NPI Number | 1164758199
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Entity Type | Organization
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Legal Business Name | STEPHEN P. BOGER, DDS, PA
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 2720 ANNAPOLIS CIRCLE SUITE A
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City | PLYMOUTH
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State | MN
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Zip | 55441
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Country | US
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Telephone | 763-546-7707
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Fax | 763-546-7713
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Provider Business Mailing Address
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Address Line | 2720 ANNAPOLIS CIRCLE SUITE A
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City | PLYMOUTH
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State | MN
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Zip | 55441
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Country | US
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Telephone | 763-546-7707
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Fax | 763-546-7713
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. STEPHEN P. BOGER
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Credential | D.D.S.
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Telephone | 763-546-7707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D8092
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License Number State | MN
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