Provider Demographics
NPI:1669569398
Name:HAGERT, CHRISTIE LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:LYNN
Last Name:HAGERT
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 1:46302 MCCLELLAN WAY
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-7243
Mailing Address - Country:US
Mailing Address - Phone:703-444-5095
Mailing Address - Fax:
Practice Address - Street 1:46302 MCCLELLAN WAY
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-7243
Practice Address - Country:US
Practice Address - Phone:703-444-5095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9178835Medicaid