Provider Demographics
NPI:1760592679
Name:HOGAN, KATHERINE RABEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:RABEN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:KATHERINE
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:115 N DIXIE DR STE 320
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5958
Mailing Address - Country:US
Mailing Address - Phone:979-297-3234
Mailing Address - Fax:979-297-5999
Practice Address - Street 1:115 N DIXIE DR STE 320
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5958
Practice Address - Country:US
Practice Address - Phone:979-297-3234
Practice Address - Fax:979-297-5999
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice