Individual
DR. RYAN DREW BOGARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
310 TRI STATE PKWY STE 100, GURNEE, IL 60031-5282
(314) 583-3104
Mailing address
1233 BLACKTHORN LN, DEERFIELD, IL 60015-3103
(314) 583-3104
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
019.033452
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019.033452
LICENSE NUMBER
IL
Enumeration date
04/28/2022
Last updated
04/28/2022
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