Provider Demographics
NPI:1720194343
Name:HAGEMAN, DAVID J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:HAGEMAN
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 1:3606 MARVIN D LOVE FWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-4442
Mailing Address - Country:US
Mailing Address - Phone:214-371-4763
Mailing Address - Fax:214-372-6057
Practice Address - Street 1:3606 MARVIN D LOVE FWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4442
Practice Address - Country:US
Practice Address - Phone:214-371-4763
Practice Address - Fax:214-372-6057
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice