MEDICARE: RICHARD H. MOGENSEN DDS APC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	CA 21733	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750595567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD H. MOGENSEN DDS APC

Provider Business Mailing Address
First Line	:	1624 FRANKLIN ST
Second Line	:	SUITE 1206
City	:	OAKLAND
State	:	CA
Zip	:	94612-2824
Country	:	US
Telephone Number	:	510-452-5555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1624 FRANKLIN ST
Second Line	:	SUITE 1206
City	:	OAKLAND
State	:	CA
Zip	:	94612-2824
Country	:	US
Telephone Number	:	510-452-5555
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD H. MOGENSEN
Credential	:	DDS
Telephone Number	:	510-452-5555

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	08/22/2020

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