Provider Demographics
NPI:1366639007
Name:BALES-KOGAN, ARIEL (DMD)
Entity Type:Individual
Prefix:MR
First Name:ARIEL
Middle Name:
Last Name:BALES-KOGAN
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 1:305 W 150TH ST
Mailing Address - Street 2:APT 701
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-2225
Mailing Address - Country:US
Mailing Address - Phone:617-319-4180
Mailing Address - Fax:
Practice Address - Street 1:79-11 41ST AVE
Practice Address - Street 2:UNIT A107
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-205-2888
Practice Address - Fax:718-205-2855
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0553731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics