Provider Demographics
NPI:1588810253
Name:HOGAN, MICHAEL HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HENRY
Last Name:HOGAN
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 1:2333 MORRIS AVE STE A111
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5737
Mailing Address - Country:US
Mailing Address - Phone:908-687-7036
Mailing Address - Fax:908-687-5215
Practice Address - Street 1:2333 MORRIS AVE STE A111
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5737
Practice Address - Country:US
Practice Address - Phone:908-687-7036
Practice Address - Fax:908-687-5215
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055343122300000X, 122300000X
NJDI023881122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03343693Medicaid