Provider Demographics
NPI:1801070875
Name:HAGEN, RONALD M (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:M
Last Name:HAGEN
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 1:8257 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7717
Mailing Address - Country:US
Mailing Address - Phone:305-667-4410
Mailing Address - Fax:305-667-8492
Practice Address - Street 1:8257 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7717
Practice Address - Country:US
Practice Address - Phone:305-667-4410
Practice Address - Fax:305-667-8492
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN68211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice