Christopher W Bogue, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

08166 Issued in IA

Practice address

703 Simon Ave
Carroll, IA 51401-2264

Phone

(712) 792-4375

Fax

(712) 792-3371

NPI assigned

Jan 4, 2007

Last updated

Oct 27, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carroll Dental Clinic P.L.C.

  dba Lake View Family Dentistry & Manilla Family Dentistry

  • Dentist
  • Carroll, IA
  • NPI 1679620520
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445904000000",
    "number": "1184771917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 SIMON AVE",
            "city": "CARROLL",
            "state": "IA",
            "postal_code": "514012264",
            "telephone_number": "712-792-4375",
            "fax_number": "712-792-3371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 SIMON AVE",
            "city": "CARROLL",
            "state": "IA",
            "postal_code": "514012264",
            "telephone_number": "712-792-4375",
            "fax_number": "712-792-3371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGUE",
        "first_name": "CHRISTOPHER",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2015-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IA",
            "license": "08166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD ID #",
            "identifier": "49002",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA ID #",
            "identifier": "180751",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1264721",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Carroll, IA
• Providers in Carroll, IA by specialty
• Dentist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.