Provider Demographics
NPI:1245386168
Name:HOGG, MARK ELLIOTT (DDS, SCD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ELLIOTT
Last Name:HOGG
Suffix:
Gender:M
Credentials:DDS, SCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 W MAIN ST
Mailing Address - Street 2:STE. 206
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-0901
Mailing Address - Country:US
Mailing Address - Phone:605-348-4868
Mailing Address - Fax:
Practice Address - Street 1:2525 W MAIN ST
Practice Address - Street 2:STE. 206
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-0901
Practice Address - Country:US
Practice Address - Phone:605-348-4868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM7341223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics