Provider Demographics
NPI:1598838583
Name:HOGAN, TIM C (DDS)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:C
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 1:402 S. WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551
Mailing Address - Country:US
Mailing Address - Phone:903-796-3821
Mailing Address - Fax:903-796-3828
Practice Address - Street 1:402 S WILLIAM ST
Practice Address - Street 2:HOGAN DENTAL CLINIC
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551
Practice Address - Country:US
Practice Address - Phone:903-796-3821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX133471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice