Provider Demographics
NPI:1093872525
Name:HAGAN RODRIGUEZ PERIODONTICS & IMPLANTS
Entity Type:Organization
Organization Name:HAGAN RODRIGUEZ PERIODONTICS & IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VERMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-336-9880
Mailing Address - Street 1:335 W LAKE LANSING RD STE 100
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8486
Mailing Address - Country:US
Mailing Address - Phone:517-336-9880
Mailing Address - Fax:517-336-9881
Practice Address - Street 1:335 W LAKE LANSING RD STE 100
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8486
Practice Address - Country:US
Practice Address - Phone:517-336-9880
Practice Address - Fax:517-336-9881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty