Provider Demographics
NPI:1396837357
Name:HOAG, JAMES D (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
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 1:430 WINDWARD WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2623
Mailing Address - Country:US
Mailing Address - Phone:406-752-8805
Mailing Address - Fax:406-752-9007
Practice Address - Street 1:430 WINDWARD WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2623
Practice Address - Country:US
Practice Address - Phone:406-752-8805
Practice Address - Fax:406-752-9007
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20181223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000111724Medicaid
20184OtherBCBS