Provider Demographics
NPI:1669584025
Name:BOGAERT, RAYMOND (DMD PHD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:BOGAERT
Suffix:
Gender:M
Credentials:DMD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19108 33RD AVE W STE A
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4728
Mailing Address - Country:US
Mailing Address - Phone:425-771-4427
Mailing Address - Fax:425-775-0878
Practice Address - Street 1:19108 33RD AVE W STE A
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4728
Practice Address - Country:US
Practice Address - Phone:425-771-4427
Practice Address - Fax:425-775-0878
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA69141223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics