Provider Demographics
NPI:1013035039
Name:MOGELL, KENNETH A (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:MOGELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 N MILITARY TRL
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6365
Mailing Address - Country:US
Mailing Address - Phone:561-394-9000
Mailing Address - Fax:561-988-1102
Practice Address - Street 1:2900 N MILITARY TRL
Practice Address - Street 2:SUITE 212
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6365
Practice Address - Country:US
Practice Address - Phone:561-394-9000
Practice Address - Fax:561-988-1102
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN101181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice