Provider Demographics
NPI:1801220447
Name:COGGAN, HEIDI (RDHAP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:COGGAN
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:FLEISCHAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:7509 DRAPER AVE
Mailing Address - Street 2:#302
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4862
Mailing Address - Country:US
Mailing Address - Phone:702-580-8885
Mailing Address - Fax:858-750-2045
Practice Address - Street 1:7509 DRAPER AVE
Practice Address - Street 2:#302
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4862
Practice Address - Country:US
Practice Address - Phone:858-754-8557
Practice Address - Fax:858-750-2045
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA476125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist