Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN13221 | FL |
NPI | 1992999866 |
---|---|
Provider Name | Jacqueline Cogan |
First Address | North Miami Beach, FL 33162-4505 |
Second Address | North Miami Beach, FL 33162-4505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2007 |
Last Update Date | 04/09/2007 |