Provider Demographics
NPI:1134275969
Name:COGAN, NONIE GEORGE (DMD)
Entity type:Individual
Prefix:DR
First Name:NONIE
Middle Name:GEORGE
Last Name:COGAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:NONIE
Other - Middle Name:J
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:8319 PRESTON HWY
Mailing Address - Street 2:SUITE # A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-5300
Mailing Address - Country:US
Mailing Address - Phone:502-966-4031
Mailing Address - Fax:502-969-9291
Practice Address - Street 1:8319 PRESTON HWY
Practice Address - Street 2:SUITE # A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-5300
Practice Address - Country:US
Practice Address - Phone:502-966-4031
Practice Address - Fax:502-969-9291
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY54971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice