Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 2206 | ND |
Y | 1223P0221X | Pediatric Dentist | 6856-15 | WI |
NPI | 1023376597 |
---|---|
Provider Name | Dr. Beth Ann Hoge |
First Address | Monona, WI 53716-4041 |
Second Address | Monona, WI 53716-4041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2012 |
Last Update Date | 20/12/2014 |