MEDICARE: DR. KARINA BOGDASAROVA DDS

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	1223P0221X	Pediatric Dentistry	30.023855	OH
2	1223P0221X	Pediatric Dentistry	DN014759	GA

General Provider Information

NPI Number	:	1518233550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARINA BOGDASAROVA DDS

Provider Business Mailing Address
First Line	:	2332 HARDESTY CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-2841
Country	:	US
Telephone Number	:	720-891-6090
Fax Number	:

Provider Business Practice Location Address
First Line	:	2332 HARDESTY CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-2841
Country	:	US
Telephone Number	:	720-891-6090
Fax Number	:

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

Provider Enumeration Date	:	03/23/2012
Last Update Date	:	07/24/2014

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