Provider Demographics
NPI:1023145216
Name:HOGAN, ERIC T (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:T
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 1:1820 VALLEY DRIVE E.
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-2701
Mailing Address - Country:US
Mailing Address - Phone:406-234-2926
Mailing Address - Fax:406-234-1590
Practice Address - Street 1:1820 VALLEY DRIVE E.
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-2701
Practice Address - Country:US
Practice Address - Phone:406-234-2926
Practice Address - Fax:406-234-1590
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21971223G0001X, 1223X0400X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0033098OtherCHIP
MT0030784Medicaid