Provider Demographics
NPI:1518950427
Name:HAGERTY, PATRICK V (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:V
Last Name:HAGERTY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:1070 24TH AVE SW
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-0213
Mailing Address - Country:US
Mailing Address - Phone:541-926-3689
Mailing Address - Fax:541-928-6088
Practice Address - Street 1:1070 24TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-7539
Practice Address - Country:US
Practice Address - Phone:541-926-3689
Practice Address - Fax:541-928-6088
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR63261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORBH0561072OtherDEA
ORBH0561072OtherDEA