Basic Information
| Provider Information | |||||||||
| NPI: | 1043281892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOSHAW | ||||||||
| FirstName: | LANI | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1335 GUSDORF RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | TAOS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875715204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057519333 | ||||||||
| FaxNumber: | 5057370483 | ||||||||
| Practice Location | |||||||||
| Address1: | 6270 W MAIN ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | EAU CLAIRE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 491119480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2694616927 | ||||||||
| FaxNumber: | 2694613068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 01/19/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DD2176 | NM | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 09258566 | 05 | NM | MEDICAID | 0015467 | 05 | NM | MEDICAID |