Provider Demographics
NPI:1144307646
Name:BOGER, PAUL LUFF (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LUFF
Last Name:BOGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-1736
Mailing Address - Country:US
Mailing Address - Phone:814-726-1240
Mailing Address - Fax:814-726-2321
Practice Address - Street 1:406 MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-1736
Practice Address - Country:US
Practice Address - Phone:814-726-1240
Practice Address - Fax:814-726-2321
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028642L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice