Provider Demographics
NPI:1154385755
Name:KOGUT, MARK HIRSH (DDS MSD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:HIRSH
Last Name:KOGUT
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8325 WALNUT HILL LN
Mailing Address - Street 2:STE 111
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:214-696-3082
Mailing Address - Fax:214-696-4607
Practice Address - Street 1:8325 WALNUT HILL LN
Practice Address - Street 2:STE 111
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-696-3082
Practice Address - Fax:214-696-4607
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX115011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry