Individual
DR. DAVID A BOGACZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
197 SANBORN RD, TILTON, NH 03276-5732
(603) 496-1683
(603) 286-7060
Mailing address
PO BOX 206, TILTON, NH 03276-0206
(603) 496-1683
(603) 286-7060
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2019
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000799
—
NH
01
—
000180773
UNITED CONCORDIA PROVIDER
NH
01
—
020390199
TAX ID #
NH
05
—
0280364
—
MA
Enumeration date
07/17/2006
Last updated
11/10/2023
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