Provider Demographics
NPI:1457496580
Name:HOGE, HENRY WILLIAM (DDS MS)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:WILLIAM
Last Name:HOGE
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 KOHLER MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3177
Mailing Address - Country:US
Mailing Address - Phone:920-452-8802
Mailing Address - Fax:920-452-2852
Practice Address - Street 1:2808 KOHLER MEMORIAL DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3177
Practice Address - Country:US
Practice Address - Phone:920-452-8802
Practice Address - Fax:920-452-2852
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50006441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics