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General NPI Number Information
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NPI Number | 1235763004
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Entity Type | Individual
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Provider Name | JORDAN S COGAN DMD
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Gender | Male
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 03/02/2020
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Provider Practice Location Address
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Address Line | 51 ALMSHOUSE RD
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City | RICHBORO
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State | PA
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Zip | 18954-1105
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Country | US
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Telephone | 215-355-5995
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Fax |
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Provider Business Mailing Address
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Address Line | 3013 E BRIGHTON ST
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City | FURLONG
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State | PA
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Zip | 18925-1551
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Country | US
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Telephone | 267-671-8727
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS040785
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License Number State | PA
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