Individual
DR. RUSSELL EDWARD BOGACKI
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8344 TRAFORD LN, SUITE 3D, SPRINGFIELD, VA 22152-1657
(703) 451-2867
(703) 991-8448
Mailing address
8344 TRAFORD LN, SUITE 3D, SPRINGFIELD, VA 22152-1657
(703) 451-2867
(703) 991-8448
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401008712
VA
Other
Enumeration date
10/31/2005
Last updated
07/08/2007
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