Samantha R Bogle, DMD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DN28672 Issued in FL

Practice address

1202 SE Port St Lucie Blvd
Port St Lucie, FL 34952-5364

Phone

(772) 335-3088

NPI assigned

May 17, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Groton Dental Wellness Center

  • Dentist
  • Groton, MA
  • NPI 1629231709
  NPD (past)
• Groton Wellness Family Dentistry,LLC

  • Dental Clinic/Center
  • Groton, MA
  • NPI 1306276969
  NPD (past)

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

{
    "created_epoch": "1494979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1770010043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1043 BAY COLONY DR S",
            "city": "JUNO BEACH",
            "state": "FL",
            "postal_code": "334082103",
            "telephone_number": "973-943-9514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 SE PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349525364",
            "telephone_number": "772-335-3088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGLE",
        "first_name": "SAMANTHA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-17",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MA",
            "license": "DN1857916",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "DN28672",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02632900",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenny Paola Bodden Martinez, MS, BS
• Patricia Malvoisin Boddie, M.S., LMHC
• David F. Boden, D.D.S., M.S.
• Haren Bodepudi, M.D.
• Carol E. Boettcher, ARNP
• Jennifer Kathleen Bogus
• Gordon George Bohl, LCSW
• Hedwige Bois-Saintil
• Richard Eric Bolander, OTR/L
• Ulecia Boldin, PHARM D

• Orthodontics and Dentofacial Orthopedics Dentistry in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.