Provider Demographics
NPI:1235763004
Name:COGAN, JORDAN S (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:S
Last Name:COGAN
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 1:3013 E BRIGHTON ST
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925-1551
Mailing Address - Country:US
Mailing Address - Phone:267-671-8727
Mailing Address - Fax:
Practice Address - Street 1:51 ALMSHOUSE RD
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1105
Practice Address - Country:US
Practice Address - Phone:215-355-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0407851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty