Provider Demographics
NPI:1992974752
Name:KOGAN, PAULINA (DDS)
Entity type:Individual
Prefix:
First Name:PAULINA
Middle Name:
Last Name:KOGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S WHITING ST STE 116
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3644
Mailing Address - Country:US
Mailing Address - Phone:703-370-3030
Mailing Address - Fax:703-370-0852
Practice Address - Street 1:250 S WHITING ST STE 116
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3644
Practice Address - Country:US
Practice Address - Phone:703-370-3030
Practice Address - Fax:703-370-0852
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014109951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice