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General NPI Number Information
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NPI Number | 1962896779
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Entity Type | Organization
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Legal Business Name | DR. RANDALL T. BOGGS
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 3416 W LASKEY RD
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City | TOLEDO
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State | OH
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Zip | 43623-4015
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Country | US
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Telephone | 419-473-8885
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Fax | 419-473-9995
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Provider Business Mailing Address
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Address Line | 3416 W LASKEY RD
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City | TOLEDO
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State | OH
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Zip | 43623-4015
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Country | US
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Telephone | 419-473-8885
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Fax | 419-473-9995
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. PAMELA JANE TEET
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Credential |
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Telephone | 419-473-8885
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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 | 15815
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License Number State | OH
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