MEDICARE: DR. RAYMOND BOGAERT DMD PHD

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	1223E0200X	Endodontics	6914	WA

General Provider Information

NPI Number	:	1669584025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND BOGAERT DMD PHD

Provider Business Mailing Address
First Line	:	19108 33RD AVE W STE A
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-4728
Country	:	US
Telephone Number	:	425-771-4427
Fax Number	:	425-775-0878

Provider Business Practice Location Address
First Line	:	19108 33RD AVE W STE A
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-4728
Country	:	US
Telephone Number	:	425-771-4427
Fax Number	:	425-775-0878

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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