Provider Demographics
NPI:1104859024
Name:HAGOPIAN, RUSSELL K (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:K
Last Name:HAGOPIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 WALTHAM ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8019
Mailing Address - Country:US
Mailing Address - Phone:781-862-8662
Mailing Address - Fax:781-862-6187
Practice Address - Street 1:922 WALTHAM ST
Practice Address - Street 2:SUITE 210
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-8019
Practice Address - Country:US
Practice Address - Phone:781-862-8662
Practice Address - Fax:781-862-6187
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA147861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice