Provider Demographics
NPI:1043360969
Name:HAGAN, JEFF A (DDS)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:A
Last Name:HAGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2900 WESTOWN PKWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1315
Mailing Address - Country:US
Mailing Address - Phone:515-223-2248
Mailing Address - Fax:515-225-2128
Practice Address - Street 1:2900 WESTOWN PKWY
Practice Address - Street 2:SUITE G
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1315
Practice Address - Country:US
Practice Address - Phone:515-223-2248
Practice Address - Fax:515-225-2128
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076451223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics