Provider Demographics
NPI:1033271937
Name:HOGGATT, WILTON ERIC (DDS)
Entity Type:Individual
Prefix:
First Name:WILTON
Middle Name:ERIC
Last Name:HOGGATT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60094 TUBB DR
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-9164
Mailing Address - Country:US
Mailing Address - Phone:830-460-0899
Mailing Address - Fax:
Practice Address - Street 1:513 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MS
Practice Address - Zip Code:39730-2543
Practice Address - Country:US
Practice Address - Phone:662-369-2063
Practice Address - Fax:662-369-2076
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1754-77122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05082803Medicaid