Healthcare Provider Details

I. General information

NPI: 1730230475
Provider Name (Legal Business Name): JOHN DARRELL HOGGLE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HOSPITAL DRIVE
LIVINGSTON AL
35470-1108
US

IV. Provider business mailing address

PO BOX 1108 105 HOSPITAL DRIVE
LIVINGSTON AL
35470-1108
US

V. Phone/Fax

Practice location:
  • Phone: 205-652-7114
  • Fax: 205-652-6889
Mailing address:
  • Phone: 205-652-7114
  • Fax: 205-652-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3514
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: