Provider Demographics
NPI:1194923243
Name:KOGAN, ELENA (DDS)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:KOGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:A
Other - Last Name:KOGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:860 W REDLANDS BLVD # 105
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8010
Mailing Address - Country:US
Mailing Address - Phone:909-793-5270
Mailing Address - Fax:909-793-7679
Practice Address - Street 1:860 W REDLANDS BLVD STE 105
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8010
Practice Address - Country:US
Practice Address - Phone:909-793-5270
Practice Address - Fax:909-793-7679
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist