Icboggan, INC
Specialist in Lafayette, CA. Organization (NPI-2).
NPI number1962035261
StatusActive
Last updated in NPPESJul 24, 2022
Details
- NPI
- 1962035261
- Entity type
- Organization (NPI-2)
- Legal business name
- Icboggan, INC
- Organization subpart
- No
- Enumeration date
- Feb 15, 2020
- Certification date
- Jul 24, 2022
- Last updated
- Jul 24, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | – | – | Yes |
| 124Q00000X | Dental Hygienist | – | – |
Other names
- Orofacial Fitness (Doing Business As)
- Nerissa T. Boggan (Doing Business As)
Practice location
3799 Mt Diablo Blvd Unit 200Lafayette, CA 94549-3545
Phone 925-962-7450
Mailing address
3799 Mt Diablo Blvd Ste 200Lafayette, CA 94549-3545
Phone 925-962-7450
Authorized official
Nerissa T Boggan
Rdh
9259627450
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