Provider Demographics
NPI:1215536081
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:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-353-5252
Mailing Address - Street 1:2900 N MILITARY TRL STE 212
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6308
Mailing Address - Country:US
Mailing Address - Phone:561-353-5252
Mailing Address - Fax:561-988-1102
Practice Address - Street 1:787 37TH ST STE E180
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7318
Practice Address - Country:US
Practice Address - Phone:772-882-6800
Practice Address - Fax:561-988-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty