=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215337357
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOGGAN ORTHODONTICS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2014
-----------------------------------------------------
Last Update Date | 08/26/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 N HARRISON AVE STE 3
-----------------------------------------------------
City | PIERRE
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57501-2376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-224-6205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 N HARRISON AVE STE 3
-----------------------------------------------------
City | PIERRE
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57501-2376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-224-6205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TODD DANIEL HOGGAN
-----------------------------------------------------
Credential | DDS, MS
-----------------------------------------------------
Telephone | 605-224-6205
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | D1041
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------