Organization
ICBOGGAN, INC
Active
Other names
Nerissa T. Boggan, Orofacial Fitness
Organization subpart
No
Provider details
NPI number
Authorized official
NERISSA T BOGGAN RDH (RDH)
(925) 962-7450
Entity
Organization
Contact information
Practice address
3799 MT DIABLO BLVD UNIT 200, LAFAYETTE, CA 94549-3545
(925) 962-7450
Mailing address
3799 MT DIABLO BLVD STE 200, LAFAYETTE, CA 94549-3545
(925) 962-7450
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
—
—
174400000X
Specialist
Primary
—
—
Other
Enumeration date
02/15/2020
Last updated
07/24/2022
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