Provider Demographics
NPI:1710291760
Name:KOGAN, MATTHEW DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name: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 1:29001 CEDAR RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4062
Mailing Address - Country:US
Mailing Address - Phone:440-646-1133
Mailing Address - Fax:440-646-1335
Practice Address - Street 1:29001 CEDAR RD
Practice Address - Street 2:SUITE 404
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-4062
Practice Address - Country:US
Practice Address - Phone:440-646-1133
Practice Address - Fax:440-646-1335
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0233091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice