Provider Demographics
NPI:1235148008
Name:HAGE, ABBIE D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABBIE
Middle Name:D
Last Name:HAGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615 VALLEY AVE. E.
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98424
Mailing Address - Country:US
Mailing Address - Phone:253-922-6822
Mailing Address - Fax:888-653-3484
Practice Address - Street 1:5615 VALLEY AVE. E.
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98424
Practice Address - Country:US
Practice Address - Phone:253-922-6822
Practice Address - Fax:888-653-3484
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000068901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5020243Medicaid