Provider Demographics
NPI:1588842967
Name:MARK J. HAGELE, DDS INC.
Entity Type:Organization
Organization Name:MARK J. HAGELE, DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HAGELE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-265-6656
Mailing Address - Street 1:707 ZION ST STE D
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2932
Mailing Address - Country:US
Mailing Address - Phone:530-265-6656
Mailing Address - Fax:
Practice Address - Street 1:707 ZION ST STE D
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2932
Practice Address - Country:US
Practice Address - Phone:530-265-6656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA394101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty