| Kenneth A Mogell Dmd Pa | |
|
1400 Pine St Ste A Melbourne FL 32901-3170 | |
| (321) 313-5350 | |
| (561) 988-1102 |
| Full Name | Kenneth A Mogell Dmd Pa |
|---|---|
| Speciality | Dentist |
| Location | 1400 Pine St Ste A, Melbourne, Florida |
| Authorized Official Name and Position | Annette Mogell (SEC/TREAS) |
| Authorized Official Contact | 5612712483 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth A Mogell Dmd Pa 2900 N Military Trl Ste 212 Boca Raton FL 33431-6308 Ph: () - | Kenneth A Mogell Dmd Pa 1400 Pine St Ste A Melbourne FL 32901-3170 Ph: (321) 313-5350 |
| NPI Number | 1285122044 |
|---|---|
| Provider Enumeration Date | 04/27/2018 |
| Last Update Date | 04/27/2018 |
| Medicare PECOS PAC ID | 0648460311 |
|---|---|
| Medicare Enrollment ID | O20211007002336 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285122044 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN10118 (Florida) | Primary |
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