Robert Keith Bogart, DMD
Individual provider Active NPI General Practice Dentistry · Wpafb, OH
NPI 1528059904 · NPPES record last updated Sep 18, 2020
Key facts
- NPI
- 1528059904
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DN011682 (GA)
- Practice address
- 4881 Sugar Maple Dr
Wpafb, OH 45433-5529 - Phone
- (937) 257-8349
- NPI assigned
- Nov 3, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201111000378 | OH | Order and Referring Only - Dentist |
4880004472 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN011682 | GA | Yes |
Addresses
Primary practice location
4881 Sugar Maple Dr
Wpafb, OH 45433-5529
Mailing address
88TH MDG/SGD
4881 Sugar Maple Dr
Wpafb, OH 45433
Phone (937) 257-6529
Other providers in Wpafb, OH
- Sarah Baker
- Christian Edward Banasky
- Joel Tyler Basenback
- Elizabeth A. Batchelor
- Brian Christopher Bentele
- Vincent Anthony Bonanno
- Jeffery Bouma
- Vera Lavonne Bowie
- Robert Allan Briggs
- Linda Susan Broeckl
All providers in Wpafb, OH · General Practice Dentistry in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.