Ryan Drew Bogard, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

019.033452 Issued in IL

Practice address

310 Tri State Pkwy Ste 100
Gurnee, IL 60031-5282

Phone

(314) 583-3104

NPI assigned

Apr 28, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1651104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651104000000",
    "number": "1740925304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 BLACKTHORN LN",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600153103",
            "telephone_number": "314-583-3104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 TRI STATE PKWY STE 100",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315282",
            "telephone_number": "314-583-3104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGARD",
        "first_name": "RYAN",
        "middle_name": "DREW",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-28",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "019.033452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "019.033452",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.