Provider Demographics
NPI:1699408922
Name:HOGAN, ALEXANDRA ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:ANN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 OTTAWA AVE NW APT 711
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4833
Mailing Address - Country:US
Mailing Address - Phone:517-285-5954
Mailing Address - Fax:
Practice Address - Street 1:15 OTTAWA AVE NW APT 711
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4833
Practice Address - Country:US
Practice Address - Phone:517-285-5954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist