Healthcare Provider Details

I. General information

NPI: 1407103419
Provider Name (Legal Business Name): DOROTNY SONYA-HOGLUND DMD, MSC, DIP ORTHO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST HSB - RM B316
SEATTLE WA
98195-6370
US

IV. Provider business mailing address

6321 NE RADFORD DR SUITE 4513
SEATTLE WA
98115-8724
US

V. Phone/Fax

Practice location:
  • Phone: 206-747-6327
  • Fax:
Mailing address:
  • Phone: 206-747-6327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License NumberDR60293015
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: