Provider Demographics
NPI:1295928059
Name:HASON, AGATHA E (DDS)
Entity type:Individual
Prefix:DR
First Name:AGATHA
Middle Name:E
Last Name:HASON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3122
Mailing Address - Country:US
Mailing Address - Phone:708-474-2590
Mailing Address - Fax:708-474-9776
Practice Address - Street 1:3341 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3122
Practice Address - Country:US
Practice Address - Phone:708-474-2590
Practice Address - Fax:708-474-9776
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190121258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist