Provider Demographics
NPI:1528189602
Name:HAGY, ROBERT RALPH SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RALPH
Last Name:HAGY
Suffix:SR
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:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24631-0017
Mailing Address - Country:US
Mailing Address - Phone:276-498-3034
Mailing Address - Fax:
Practice Address - Street 1:10941 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:VA
Practice Address - Zip Code:24631
Practice Address - Country:US
Practice Address - Phone:276-498-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010039621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice