Provider Demographics
NPI:1316045990
Name:HOGAN, K. CAROLYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:K.
Middle Name:CAROLYN
Last Name:HOGAN
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 1:4235 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4766
Mailing Address - Country:US
Mailing Address - Phone:602-954-2451
Mailing Address - Fax:602-954-8128
Practice Address - Street 1:4235 N 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4766
Practice Address - Country:US
Practice Address - Phone:602-954-2451
Practice Address - Fax:602-954-8128
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD27211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice