Provider Demographics
NPI:1952642274
Name:KOGAN, MASHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MASHA
Middle Name:
Last Name:KOGAN
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 1:175 POST RD W
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4643
Mailing Address - Country:US
Mailing Address - Phone:203-227-8700
Mailing Address - Fax:203-227-0680
Practice Address - Street 1:175 POST RD W
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4643
Practice Address - Country:US
Practice Address - Phone:203-227-8700
Practice Address - Fax:203-227-0680
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8491122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist