Provider Demographics
NPI:1437319878
Name:DR. HAGEMAN DDS
Entity Type:Organization
Organization Name:DR. HAGEMAN DDS
Other - Org Name:DR. HAGEMAN FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:INSURANCE AND BILLING REP.
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MATHESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-371-4763
Mailing Address - Street 1:3606 MARVIN D LOVE FWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-4442
Mailing Address - Country:US
Mailing Address - Phone:214-371-4763
Mailing Address - Fax:214-372-6057
Practice Address - Street 1:3606 MARVIN D LOVE FWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4442
Practice Address - Country:US
Practice Address - Phone:214-371-4763
Practice Address - Fax:214-372-6057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009688501Medicaid