Provider Demographics
NPI:1770469421
Name:COGEN, SHANNON (PUBLIC HEALTH RDH)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:COGEN
Suffix:
Gender:F
Credentials:PUBLIC HEALTH RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 BIGELOW ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3878
Mailing Address - Country:US
Mailing Address - Phone:704-935-6038
Mailing Address - Fax:
Practice Address - Street 1:5301 WILKINSON BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5455
Practice Address - Country:US
Practice Address - Phone:704-384-1523
Practice Address - Fax:704-384-1497
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9943124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist