MEDICARE: DR. THERESE MARIE BOGS 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	1223G0001X	General Practice Dentistry	019-022073	IL

General Provider Information

NPI Number	:	1891831749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESE MARIE BOGS DDS

Provider Business Mailing Address
First Line	:	26634 S WINFIELD RD
Second Line	:
City	:	MONEE
State	:	IL
Zip	:	60449-9220
Country	:	US
Telephone Number	:	708-534-7818
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 MONEE MANHATTAN RD STE 117
Second Line	:
City	:	MONEE
State	:	IL
Zip	:	60449-8866
Country	:	US
Telephone Number	:	708-534-9700
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	01/28/2009

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