Provider Demographics
NPI:1902865231
Name:HAGERTY, KEVIN PATRICK (DMD)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:PATRICK
Last Name:HAGERTY
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 1:61 CEDAR AVENUE
Mailing Address - Street 2:STEEPLE VIEW EAST, #5
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3161
Mailing Address - Country:US
Mailing Address - Phone:401-884-4874
Mailing Address - Fax:401-884-4928
Practice Address - Street 1:61 CEDAR AVENUE
Practice Address - Street 2:STEEPLE VIEW EAST, #5
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3190
Practice Address - Country:US
Practice Address - Phone:401-884-4874
Practice Address - Fax:401-884-4928
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI21551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIKH00257Medicaid
RI8048-6OtherBLUE CROSS DENTAL RI
RI199008048Medicare Oscar/Certification