Provider Demographics
NPI:1952329526
Name:MOGA, IRINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:MOGA
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 1:14425 SW ALLEN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4402
Mailing Address - Country:US
Mailing Address - Phone:503-646-5909
Mailing Address - Fax:503-646-5909
Practice Address - Street 1:14425 SW ALLEN BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4402
Practice Address - Country:US
Practice Address - Phone:503-646-5909
Practice Address - Fax:503-646-5908
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD85101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice