MEDICARE: BOGEY HILLS DENTAL LLC

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	14575	MO

General Provider Information

NPI Number	:	1437480712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOGEY HILLS DENTAL LLC

Provider Business Mailing Address
First Line	:	1008 COUNTRY CLUB RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3364
Country	:	US
Telephone Number	:	636-946-0767
Fax Number	:	636-946-0772

Provider Business Practice Location Address
First Line	:	1008 COUNTRY CLUB RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3364
Country	:	US
Telephone Number	:	636-946-0767
Fax Number	:	636-946-0772

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	FRANK MEIER
Credential	:
Telephone Number	:	636-946-0767

Provider Enumeration Date	:	01/26/2010
Last Update Date	:	01/26/2010

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