Provider Demographics
NPI:1225114960
Name:HAGOPIAN, JOHN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:HAGOPIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S WASHINGTON AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4200
Mailing Address - Country:US
Mailing Address - Phone:847-692-7760
Mailing Address - Fax:847-692-2264
Practice Address - Street 1:101 S WASHINGTON AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4200
Practice Address - Country:US
Practice Address - Phone:847-692-7760
Practice Address - Fax:847-692-2264
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190180681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice