Provider Demographics
NPI:1891281697
Name:COGAN, ALISA MORGAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:MORGAN
Last Name:COGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10338 PANAMA ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4529
Mailing Address - Country:US
Mailing Address - Phone:954-292-2383
Mailing Address - Fax:
Practice Address - Street 1:812 SW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2939
Practice Address - Country:US
Practice Address - Phone:772-287-1671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23235122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist