Healthcare Provider Details

I. General information

NPI: 1851459143
Provider Name (Legal Business Name): KOGAN & KOGAN DENTAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29001 CEDAR RD. SUITE 404
LYNDHURST OH
44124
US

IV. Provider business mailing address

29001 CEDAR RD. SUITE 404
LYNDHURST OH
44124
US

V. Phone/Fax

Practice location:
  • Phone: 440-646-1133
  • Fax: 440-646-1335
Mailing address:
  • Phone: 440-646-1133
  • Fax: 440-646-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16438
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16438
License Number StateOH

VIII. Authorized Official

Name: DR. NEIL J. KOGAN
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 440-646-1133