Provider Demographics
NPI:1649367350
Name:HOGAN, EVA L (MUDR DDS MS)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:L
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MUDR DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11980 SAN VICENTE BLVD
Mailing Address - Street 2:503
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049
Mailing Address - Country:US
Mailing Address - Phone:310-966-9444
Mailing Address - Fax:310-820-4585
Practice Address - Street 1:11980 SAN VICENTE BLVD
Practice Address - Street 2:503
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049
Practice Address - Country:US
Practice Address - Phone:310-966-9444
Practice Address - Fax:310-820-4585
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADS451131223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics