Provider Demographics
NPI:1336225812
Name:HAGARTY, MATTHEW SEAN (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SEAN
Last Name:HAGARTY
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:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:IA
Mailing Address - Zip Code:50054-0155
Mailing Address - Country:US
Mailing Address - Phone:515-674-4466
Mailing Address - Fax:515-674-3123
Practice Address - Street 1:475 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:IA
Practice Address - Zip Code:50054-9600
Practice Address - Country:US
Practice Address - Phone:515-674-4466
Practice Address - Fax:515-674-3123
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA83411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1463505Medicaid
IA39305OtherBCBS