Provider Demographics
NPI:1104928159
Name:HOGGAN, BRUCE WALTER (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WALTER
Last Name:HOGGAN
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 1:225 CALLAHAN AVE.
Mailing Address - Street 2:
Mailing Address - City:PARACHUTE
Mailing Address - State:CO
Mailing Address - Zip Code:81635
Mailing Address - Country:US
Mailing Address - Phone:970-285-7748
Mailing Address - Fax:970-285-6824
Practice Address - Street 1:225 CALLAHAN AVE.
Practice Address - Street 2:
Practice Address - City:PARACHUTE
Practice Address - State:CO
Practice Address - Zip Code:81635
Practice Address - Country:US
Practice Address - Phone:970-285-7748
Practice Address - Fax:970-285-6824
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist