Provider Demographics
NPI:1790838605
Name:HOAGLIN, DONALD R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:HOAGLIN
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 1:18301 N 79TH AVE STE G185
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6093
Mailing Address - Country:US
Mailing Address - Phone:623-931-9198
Mailing Address - Fax:
Practice Address - Street 1:18301 N 79TH AVE STE G185
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6093
Practice Address - Country:US
Practice Address - Phone:623-931-9198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51511223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology