Provider Demographics
NPI:1114242393
Name:KENNETH A. MOGELL, DMD, PA
Entity Type:Organization
Organization Name:KENNETH A. MOGELL, DMD, PA
Other - Org Name:FLORIDA DENTAL SLEEP DISORDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-270-2349
Mailing Address - Street 1:2900 N MILITARY TRL
Mailing Address - Street 2:STE. 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:561-477-2947
Practice Address - Street 1:2900 N MILITARY TRL
Practice Address - Street 2:STE. 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:561-477-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 10118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6378940001Medicare NSC