Provider Demographics
NPI:1043281892
Name:HOSHAW, LANI LEIGH (DDS)
Entity Type:Individual
Prefix:
First Name:LANI
Middle Name:LEIGH
Last Name:HOSHAW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 GUSDORF RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5204
Mailing Address - Country:US
Mailing Address - Phone:505-751-9333
Mailing Address - Fax:505-737-0483
Practice Address - Street 1:6270 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:EAU CLAIRE
Practice Address - State:MI
Practice Address - Zip Code:49111-9480
Practice Address - Country:US
Practice Address - Phone:269-461-6927
Practice Address - Fax:269-461-3068
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM09258566Medicaid
NM0015467Medicaid