Provider Demographics
NPI:1851584502
Name:JOHN J. HAGERTY DDS, PC
Entity Type:Organization
Organization Name:JOHN J. HAGERTY DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HAGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-886-9696
Mailing Address - Street 1:4912 W ST JOE HWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4090
Mailing Address - Country:US
Mailing Address - Phone:517-886-9696
Mailing Address - Fax:517-886-9373
Practice Address - Street 1:4912 W ST JOE HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4090
Practice Address - Country:US
Practice Address - Phone:517-886-9696
Practice Address - Fax:517-886-9373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI09235261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental