Provider Demographics
NPI:1043318215
Name:HOGAN, LISA ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:BROWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1621 E FLAMINGO RD
Mailing Address - Street 2:SUITE 17-A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5276
Mailing Address - Country:US
Mailing Address - Phone:702-892-0390
Mailing Address - Fax:702-892-0910
Practice Address - Street 1:1621 E FLAMINGO RD
Practice Address - Street 2:SUITE 17-A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5276
Practice Address - Country:US
Practice Address - Phone:702-892-0390
Practice Address - Fax:702-892-0910
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2977122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist