Provider Demographics
NPI:1730226911
Name:BOGLE, GARY C (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:C
Last Name:BOGLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ALTURAS ST STE 6
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4144
Mailing Address - Country:US
Mailing Address - Phone:909-792-0774
Mailing Address - Fax:
Practice Address - Street 1:215 CAJON ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5201
Practice Address - Country:US
Practice Address - Phone:909-793-7090
Practice Address - Fax:909-792-5050
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA206121223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics