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General NPI Number Information
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NPI Number | 1720153257
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Entity Type | Individual
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Provider Name | RANDY J. BOGARD DMD, MD
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 485 W HORTON RD STE 101
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City | BELLINGHAM
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State | WA
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Zip | 98226-1205
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Country | US
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Telephone | 360-483-0180
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Fax | 360-306-3742
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Provider Business Mailing Address
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Address Line | 485 W HORTON RD STE 101
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City | BELLINGHAM
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State | WA
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Zip | 98226-1205
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Country | US
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Telephone | 360-483-0180
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Fax | 360-306-3742
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DE00008501
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License Number State | WA
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