Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 28094 | TX |
Y | 1223P0221X | Pediatric Dentist | 28094 | TX |
NPI | 1093075830 |
---|---|
Provider Name | Dr. Steven Michael Hogan |
First Address | Houston, TX 77063-1612 |
Second Address | Houston, TX 77063-1612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2012 |
Last Update Date | 18/12/2018 |