Healthcare Provider Details

I. General information

NPI: 1164282570
Provider Name (Legal Business Name): HONEST PRACTICES WEST DELRAY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 03/21/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8778 W. ATLANTIC AVE
DELRAY BEACH FL
33446
US

IV. Provider business mailing address

8278 BANPO BRIDGE WAY
DELRAY BEACH FL
33446-0031
US

V. Phone/Fax

Practice location:
  • Phone: 561-206-2025
  • Fax:
Mailing address:
  • Phone: 201-406-6596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK KOGAN
Title or Position: CHIEF CLINICAL OFFICER
Credential: DMD, MD
Phone: 201-406-6596