Provider Demographics
NPI:1497869200
Name:HAGGERTY, JAMES BLAIR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BLAIR
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 1:4210 W SYLVANIA AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4500
Mailing Address - Country:US
Mailing Address - Phone:419-472-5006
Mailing Address - Fax:
Practice Address - Street 1:4210 W SYLVANIA AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4500
Practice Address - Country:US
Practice Address - Phone:419-472-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30014671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist