MEDICARE: DR. DOUGLAS BOGART DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	10453	FL

General Provider Information

NPI Number	:	1144244187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS BOGART DMD

Provider Business Mailing Address
First Line	:	3581 E GULF TO LAKE HWY
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34453-3210
Country	:	US
Telephone Number	:	352-344-9500
Fax Number	:	352-344-4398

Provider Business Practice Location Address
First Line	:	3581 E GULF TO LAKE HWY
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34453-3210
Country	:	US
Telephone Number	:	352-344-9500
Fax Number	:	352-344-4398

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	01/07/2013

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