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General NPI Number Information
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NPI Number | 1942529938
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Entity Type | Individual
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Provider Name | MARTIN JAMES HOGAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2010
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 445 E OHIO ST APT. #2509
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City | CHICAGO
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State | IL
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Zip | 60611-3302
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Country | US
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Telephone | 248-434-7831
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Fax |
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Provider Business Mailing Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-9000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 019028245
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.028245
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License Number State | IL
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