Provider Demographics
NPI:1730230475
Name:HOGGLE, JOHN DARRELL (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DARRELL
Last Name:HOGGLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:105 HOSPITAL DRIVE
Mailing Address - City:LIVINGSTON
Mailing Address - State:AL
Mailing Address - Zip Code:35470-1108
Mailing Address - Country:US
Mailing Address - Phone:205-652-7114
Mailing Address - Fax:205-652-6889
Practice Address - Street 1:105 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:35470-1108
Practice Address - Country:US
Practice Address - Phone:205-652-7114
Practice Address - Fax:205-652-6889
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-93330OtherBCBS PREFERRED PROVIDER N