# MR. MARK R BOGNAR

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1952319832
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901019957 | MI | Yes |
| 122300000X | Dentist | 3856015 | WI | — |

## Other

- **Enumeration date:** 08/04/2006
- **Last updated:** 03/09/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33731100 | — | WI |
| 01 | — | 45575 | SECURITY HEALTH PLAN | WI |