Provider Demographics
NPI:1942529938
Name:HOGAN, MARTIN JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JAMES
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 1:445 E OHIO ST
Mailing Address - Street 2:APT. #2509
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3302
Mailing Address - Country:US
Mailing Address - Phone:248-434-7831
Mailing Address - Fax:
Practice Address - Street 1:445 E OHIO ST
Practice Address - Street 2:APT. #2509
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3302
Practice Address - Country:US
Practice Address - Phone:248-434-7831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-31
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0282451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice