Active NPI
Louis E Bogard, DDS
- Dentist
- Bolivar, TN
National Provider Identifier
1225174287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS0000006956
- Practice address
- 10825 Old Hwy 64
Bolivar, TN 38008 - Phone
- (731) 658-5291
- Fax
- (731) 658-6536
- NPI assigned
- Jan 29, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS0000006956 | TN | Primary |
Addresses
Primary practice location
10825 Old Hwy 64
Bolivar, TN 38008
Mailing address
PO Box 670
10825 Old Hwy 64
Bolivar, TN 38008
Phone (731) 658-5291
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9179020 | Other | DORAL DENTAL | |
| S440640 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS0000006956 | TN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225174287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 670",
"address_2": "10825 OLD HWY 64",
"city": "BOLIVAR",
"state": "TN",
"postal_code": "38008",
"telephone_number": "731-658-5291",
"fax_number": "731-658-6536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10825 OLD HWY 64",
"city": "BOLIVAR",
"state": "TN",
"postal_code": "38008",
"telephone_number": "731-658-5291",
"fax_number": "731-658-6536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGARD",
"first_name": "LOUIS",
"middle_name": "E",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TN",
"license": "DS0000006956",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DORAL DENTAL",
"identifier": "9179020",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "S440640",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bolivar, TN
- Tynetta Qunique Beamon-Simpson, APRN
- Beautiful Minds Mental Health Services
- Maggie G. Billings, FNP, BC
- Hannah Black, DPT
- John Lee Blankenship, M.D.
- Bolivar Assisted Care Living, LLC
- Bolivar General Hospital Pharmacy (Bolivar General Hospital)
- Bolivar General Hospital, Inc. (Bolivar ER)
- Bolivar General Hospital, Inc. (West Tennessee Healthcare Bolivar Hospital)
- Bolivar General Hospital, Inc. (West Tennessee Medical Group Primary Care Bolivar)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.