MEDICARE: PAUL KOGAN DDS

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	1223E0200X	Endodontics	D6524	AZ

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	:	1174598916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL KOGAN DDS

Provider Business Mailing Address
First Line	:	702 E BELL RD
Second Line	:	SUITE 111
City	:	PHOENIX
State	:	AZ
Zip	:	85022-6639
Country	:	US
Telephone Number	:	602-482-7000
Fax Number	:	602-482-7021

Provider Business Practice Location Address
First Line	:	702 E BELL RD
Second Line	:	SUITE 111
City	:	PHOENIX
State	:	AZ
Zip	:	85022-6639
Country	:	US
Telephone Number	:	602-404-3800
Fax Number	:	602-404-8757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	11/07/2014

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