Provider Demographics
NPI:1114239183
Name:HOAG, DAVID EDWIN (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWIN
Last Name:HOAG
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 1:600 WEST THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906
Mailing Address - Country:US
Mailing Address - Phone:419-522-6191
Mailing Address - Fax:419-526-4911
Practice Address - Street 1:600 WEST THIRD STREET
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906
Practice Address - Country:US
Practice Address - Phone:419-522-6191
Practice Address - Fax:419-526-4911
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30023241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist