Provider Demographics
NPI:1962025791
Name:COGO, MICHAELA SUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:SUE
Last Name:COGO
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 1:4500 TOWN CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3435
Mailing Address - Country:US
Mailing Address - Phone:810-733-1410
Mailing Address - Fax:
Practice Address - Street 1:4500 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3435
Practice Address - Country:US
Practice Address - Phone:810-733-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016004651223G0001X
MI53152169471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice