Provider Demographics
NPI:1346281508
Name:COGAN, MICHAEL LESLIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LESLIE
Last Name:COGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 N BAYSHORE DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1180
Mailing Address - Country:US
Mailing Address - Phone:305-358-0282
Mailing Address - Fax:305-381-6848
Practice Address - Street 1:1717 N BAYSHORE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1180
Practice Address - Country:US
Practice Address - Phone:305-358-0282
Practice Address - Fax:305-381-6848
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00056531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice