Provider Demographics
NPI:1043302904
Name:BRIAN C COGBILL DDS PROF CORP
Entity Type:Organization
Organization Name:BRIAN C COGBILL DDS PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:COGBILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-446-3153
Mailing Address - Street 1:622 WEST DUARTE ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-9271
Mailing Address - Country:US
Mailing Address - Phone:626-446-3153
Mailing Address - Fax:
Practice Address - Street 1:622 WEST DUARTE ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9271
Practice Address - Country:US
Practice Address - Phone:626-446-3153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty