Healthcare Provider Details

I. General information

NPI: 1518009026
Provider Name (Legal Business Name): DONALD WILLIAM HOGAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 BROOKFIELD RD
COLUMBIA SC
29223-2212
US

IV. Provider business mailing address

7007 BROOKFIELD RD
COLUMBIA SC
29223-2212
US

V. Phone/Fax

Practice location:
  • Phone: 803-788-7447
  • Fax: 803-788-4409
Mailing address:
  • Phone: 803-788-7447
  • Fax: 803-788-4409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3167 0420
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: