Provider Demographics
NPI:1962508408
Name:HAGERMAN, STEVEN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:HAGERMAN
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 1:1605 MINNEHAHA AVE W
Mailing Address - Street 2:101
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1255
Mailing Address - Country:US
Mailing Address - Phone:651-646-2392
Mailing Address - Fax:
Practice Address - Street 1:1605 MINNEHAHA AVE W
Practice Address - Street 2:101
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1255
Practice Address - Country:US
Practice Address - Phone:651-646-2392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN94771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice