Provider Demographics
NPI:1710139191
Name:HAGARTY FAMILY DENTAL PC
Entity Type:Organization
Organization Name:HAGARTY FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:HAGARTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-351-9723
Mailing Address - Street 1:2180 NORCOR AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-9748
Mailing Address - Country:US
Mailing Address - Phone:319-351-9723
Mailing Address - Fax:
Practice Address - Street 1:2180 NORCOR AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-9748
Practice Address - Country:US
Practice Address - Phone:319-351-9723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA83411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty