Provider Demographics
NPI:1851478440
Name:HAGEN, MICHAEL H (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:HAGEN
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 1:3575 RESERVE COMMONS DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5340
Mailing Address - Country:US
Mailing Address - Phone:330-725-9851
Mailing Address - Fax:330-764-3070
Practice Address - Street 1:3575 RESERVE COMMONS DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5340
Practice Address - Country:US
Practice Address - Phone:330-725-9851
Practice Address - Fax:330-764-3070
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30015856122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist