Provider Demographics
NPI:1700938248
Name:MOGA, JANA (LD LICENSED DENTURIS)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:MOGA
Suffix:
Gender:F
Credentials:LD LICENSED DENTURIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 FORT VANCOUVER WAY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663
Mailing Address - Country:US
Mailing Address - Phone:360-694-2316
Mailing Address - Fax:
Practice Address - Street 1:2314 FORT VANCOUVER WAY
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663
Practice Address - Country:US
Practice Address - Phone:360-694-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000005122400000X
ORDTDO302276122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist