Provider Demographics
NPI:1689765547
Name:HOGAN, GRANT MICHAEL (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:MICHAEL
Last Name:HOGAN
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Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:1380 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3769
Mailing Address - Country:US
Mailing Address - Phone:770-232-1191
Mailing Address - Fax:770-232-2733
Practice Address - Street 1:1380 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3769
Practice Address - Country:US
Practice Address - Phone:770-232-1191
Practice Address - Fax:770-232-2733
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-08-26
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Provider Licenses
StateLicense IDTaxonomies
GA0574791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery