MEDICARE: DR. JEANETTE TRUONG HAGER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	43258	CA

General Provider Information

NPI Number	:	1316299175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEANETTE TRUONG HAGER D.D.S.

Provider Business Mailing Address
First Line	:	885 SCOTT BLVD STE 3
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-5255
Country	:	US
Telephone Number	:	408-244-3629
Fax Number	:	408-244-7137

Provider Business Practice Location Address
First Line	:	885 SCOTT BLVD STE 3
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-5255
Country	:	US
Telephone Number	:	408-244-3629
Fax Number	:	408-244-7137

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	06/15/2015

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