Provider Demographics
NPI:1407938012
Name:HAGGERTY, STEPHEN F (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:F
Last Name:HAGGERTY
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 1:361 ROCK RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1842
Mailing Address - Country:US
Mailing Address - Phone:201-445-3819
Mailing Address - Fax:201-445-1249
Practice Address - Street 1:361 ROCK RD
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1842
Practice Address - Country:US
Practice Address - Phone:201-445-3819
Practice Address - Fax:201-445-1249
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ107091223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ19934Medicare UPIN