Provider Demographics
NPI:1538399357
Name:BOGER, ZACHARY IAN (DDS)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:IAN
Last Name:BOGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ZACK
Other - Middle Name:
Other - Last Name:BOGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2074 FOREST AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4811
Mailing Address - Country:US
Mailing Address - Phone:408-286-3229
Mailing Address - Fax:408-286-0124
Practice Address - Street 1:2074 FOREST AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4811
Practice Address - Country:US
Practice Address - Phone:408-286-3229
Practice Address - Fax:408-286-0124
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist