Michael Bruce Hogan, DDS
Individual provider Active NPI Public Health Dentistry · Camdenton, MO
NPI 1104010255 · NPPES record last updated Aug 31, 2007
Key facts
- NPI
- 1104010255
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Public Health Dentistry 1223D0001X
- License
- 012009 (MO)
- Practice address
- 108 Cecil St Ste G
Camdenton, MO 65020-7066 - Phone
- (573) 317-1473
- NPI assigned
- Aug 31, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012009 | MO | MD | Public Health Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kirby J. Robinson, DDS of Missouri, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health Dentistry | 1223D0001X | 012009 | MO | Yes |
Addresses
Primary practice location
108 Cecil St Ste G
Camdenton, MO 65020-7066
Mailing address
108 Cecil St Ste G
Camdenton, MO 65020-7066
Phone (573) 317-1473
Other providers in Camdenton, MO
- Courtney Griswold
- Dawn Michelle Hall
- Michelle Alane Helton
- Sasha Lee Heslet
- Bertram Edward Hessler
- Infinity Endeavors
- Zachary Ryan Ingram
- Vincent Michael Israel
- Linda S Jabbari
- James E Parker
All providers in Camdenton, MO · Public Health Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.