Provider Demographics
NPI:1497874390
Name:HAGER, DONNA KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:KAY
Last Name:HAGER
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 1:3108 PROSPERITY CHURCH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269
Mailing Address - Country:US
Mailing Address - Phone:704-594-9600
Mailing Address - Fax:704-547-8865
Practice Address - Street 1:3108 PROSPERITY CHURCH RD.
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTE,
Practice Address - State:NC
Practice Address - Zip Code:28269
Practice Address - Country:US
Practice Address - Phone:704-594-9600
Practice Address - Fax:704-547-8865
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC55981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993467Medicaid