Provider Demographics
NPI:1629294541
Name:HAGERMAN, CARTER F (DMD)
Entity Type:Individual
Prefix:
First Name:CARTER
Middle Name:F
Last Name:HAGERMAN
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 1:10 W HUNT AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3018
Mailing Address - Country:US
Mailing Address - Phone:928-774-1481
Mailing Address - Fax:928-214-9388
Practice Address - Street 1:10 W HUNT AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3018
Practice Address - Country:US
Practice Address - Phone:928-774-1481
Practice Address - Fax:928-214-9388
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ59061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice