Provider Demographics
NPI:1780947416
Name:HAGERTY, DYLAN (DMD)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:
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 1:902 N US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-3544
Mailing Address - Country:US
Mailing Address - Phone:813-645-6491
Mailing Address - Fax:
Practice Address - Street 1:902 N US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-3544
Practice Address - Country:US
Practice Address - Phone:813-645-6491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19794122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist