Provider Demographics
NPI:1841818432
Name:MOGY, AUSTIN (DMD)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:MOGY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 AQUADALE RD
Mailing Address - Street 2:
Mailing Address - City:OAKBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28129-9045
Mailing Address - Country:US
Mailing Address - Phone:704-485-2400
Mailing Address - Fax:
Practice Address - Street 1:209 AQUADALE RD
Practice Address - Street 2:
Practice Address - City:OAKBORO
Practice Address - State:NC
Practice Address - Zip Code:28129-9045
Practice Address - Country:US
Practice Address - Phone:704-485-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC119951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program