Provider Demographics
NPI:1669587820
Name:SOGAN, JENNIFER R (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:SOGAN
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 1:116 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-1229
Mailing Address - Country:US
Mailing Address - Phone:740-852-5771
Mailing Address - Fax:740-852-6850
Practice Address - Street 1:116 E HIGH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1229
Practice Address - Country:US
Practice Address - Phone:740-852-5771
Practice Address - Fax:740-852-6850
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH220351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice