Provider Demographics
NPI:1164709531
Name:HAGAN DENTISTRY, P.L.L.C
Entity Type:Organization
Organization Name:HAGAN DENTISTRY, P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:D,M,D,
Authorized Official - Phone:423-239-8021
Mailing Address - Street 1:3058 FORT HENRY DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664
Mailing Address - Country:US
Mailing Address - Phone:423-239-8021
Mailing Address - Fax:423-239-6273
Practice Address - Street 1:3058 FORT HENRY DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664
Practice Address - Country:US
Practice Address - Phone:423-239-8021
Practice Address - Fax:423-239-6273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-13
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS89251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty