Provider Demographics
NPI:1225347081
Name:EARL BOGROW DDS PC
Entity type:Organization
Organization Name:EARL BOGROW DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOGROW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-827-1900
Mailing Address - Street 1:28411 NORTHWESTERN HWY
Mailing Address - Street 2:STE 225
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5508
Mailing Address - Country:US
Mailing Address - Phone:248-827-1900
Mailing Address - Fax:248-827-0949
Practice Address - Street 1:28411 NORTHWESTERN HWY STE 230
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-5548
Practice Address - Country:US
Practice Address - Phone:248-827-1900
Practice Address - Fax:248-827-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL13760411223G0001X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6445060001Medicare NSC