Healthcare Provider Details

I. General information

NPI: 1851532568
Provider Name (Legal Business Name): ELENA OGAN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 02/13/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W COLORADO AVE STE 206
COLORADO SPRINGS CO
80903-3338
US

IV. Provider business mailing address

6665 GLADE PARK DR
COLORADO SPRINGS CO
80918-4722
US

V. Phone/Fax

Practice location:
  • Phone: 719-447-1199
  • Fax:
Mailing address:
  • Phone: 916-677-9097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00205889
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02401300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS100984
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS039391
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: