Provider Demographics
NPI:1598715484
Name:HAGER, TAM S (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAM
Middle Name:S
Last Name:HAGER
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:PSC 3 BOX 1374
Mailing Address - Street 2:
Mailing Address - City:APO AE
Mailing Address - State:NY
Mailing Address - Zip Code:09021
Mailing Address - Country:US
Mailing Address - Phone:631-536-7655
Mailing Address - Fax:
Practice Address - Street 1:PSC 3 BOX 1374
Practice Address - Street 2:
Practice Address - City:APO AE
Practice Address - State:NY
Practice Address - Zip Code:09021
Practice Address - Country:US
Practice Address - Phone:631-536-7655
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY54121223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics