Provider Demographics
NPI:1689232175
Name:COGAN, PAIGE HIGDON (DMD)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:HIGDON
Last Name:COGAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:HIGDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:711 MILL ST
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1516
Mailing Address - Country:US
Mailing Address - Phone:270-589-1563
Mailing Address - Fax:
Practice Address - Street 1:1009 ALTA VISTA RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1727
Practice Address - Country:US
Practice Address - Phone:270-589-1563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist