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General NPI Number Information
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NPI Number | 1730528720
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Entity Type | Organization
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Legal Business Name | BELLINGHAM ORAL SURGERY AND DENTAL IMPLANTS
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Dates
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Enumeration Date | 06/23/2013
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Last Update Date | 06/23/2013
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Provider Practice Location Address
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Address Line | 192 E BAKERVIEW RD SUITE 101
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City | BELLINGHAM
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State | WA
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Zip | 98226-8179
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Country | US
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Telephone | 360-990-0039
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Fax |
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Provider Business Mailing Address
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Address Line | 8012 72ND DR NE
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City | MARYSVILLE
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State | WA
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Zip | 98270-7890
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Country | US
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Telephone | 360-990-0039
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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. RANDY J BOGARD
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Credential | D.M.D
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Telephone | 360-990-0039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | DE00008501
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License Number State | WA
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