Provider Demographics
NPI:1417193467
Name:HAGERTY FAMILY DENTAL, P.A.
Entity Type:Organization
Organization Name:HAGERTY FAMILY DENTAL, P.A.
Other - Org Name:HAGERYT FAMILY DENTAL, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HAGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-967-8881
Mailing Address - Street 1:2203 E PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-2105
Mailing Address - Country:US
Mailing Address - Phone:479-967-8881
Mailing Address - Fax:479-967-4751
Practice Address - Street 1:2203 E PARKWAY DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-2105
Practice Address - Country:US
Practice Address - Phone:479-967-8881
Practice Address - Fax:479-967-4751
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAGERTY FAMILY DENTAL, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR32411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty