Provider Demographics
NPI:1780293480
Name:HOAGBURG, BRIAN JEFFREY (DDS, MSD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JEFFREY
Last Name:HOAGBURG
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9409 ILLINOIS RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-5795
Mailing Address - Country:US
Mailing Address - Phone:260-486-4400
Mailing Address - Fax:
Practice Address - Street 1:9409 ILLINOIS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5795
Practice Address - Country:US
Practice Address - Phone:260-486-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013167A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics