Provider Demographics
NPI:1851532568
Name:OGAN, ELENA (DMD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:OGAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LARDNER RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4228
Mailing Address - Country:US
Mailing Address - Phone:201-835-3753
Mailing Address - Fax:
Practice Address - Street 1:183 BLUE RAVINE RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4704
Practice Address - Country:US
Practice Address - Phone:916-983-8870
Practice Address - Fax:916-985-9915
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1009841223G0001X
PADS039391122300000X
NJ22DI02401300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist