MEDICARE: LYELL R HOGG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	07778	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437182961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYELL R HOGG DDS

Provider Business Mailing Address
First Line	:	1010 4TH ST SW STE 340
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-2856
Country	:	US
Telephone Number	:	641-424-1656
Fax Number	:	641-424-2219

Provider Business Practice Location Address
First Line	:	1010 4TH ST SW STE 340
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-2856
Country	:	US
Telephone Number	:	641-424-1656
Fax Number	:	641-424-2219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	07/08/2007

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Directions to “ LYELL R HOGG DDS” Practice Location

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