Healthcare Provider Details

I. General information

NPI: 1215337357
Provider Name (Legal Business Name): HOGGAN ORTHODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N HARRISON AVE STE 3
PIERRE SD
57501-2376
US

IV. Provider business mailing address

1601 N HARRISON AVE STE 3
PIERRE SD
57501-2376
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-6205
  • Fax:
Mailing address:
  • Phone: 605-224-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD1041
License Number StateSD

VIII. Authorized Official

Name: DR. TODD DANIEL HOGGAN
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 605-224-6205