Provider Demographics
NPI:1619921939
Name:HAGAN, CHARLES ERIC (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ERIC
Last Name:HAGAN
Suffix:
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 1:335 W LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1437
Mailing Address - Country:US
Mailing Address - Phone:517-336-9880
Mailing Address - Fax:517-336-9881
Practice Address - Street 1:335 W LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1437
Practice Address - Country:US
Practice Address - Phone:517-336-9880
Practice Address - Fax:517-336-9881
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010171001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics