Individual
ELIAS BOGALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
645 CLASSIC CT, VIERA, FL 32940-8670
(321) 253-8500
Mailing address
645 CLASSIC CT, VIERA, FL 32940-8670
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS043979
PA
1223E0200X
Endodontics
Primary
DN27808
FL
1223G0001X
General Practice Dentistry
DN27808
FL
Other
Enumeration date
05/02/2022
Last updated
06/26/2025
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