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NPI Code Detail

MEDICARE: DR. JOHN G. HASBROUCK DDS

MEDICARE:  DR. JOHN G. HASBROUCK  DDS
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
11223G0001XGeneral Practice Dentistry15759OH

General Provider Information

NPI Number : 1518986991
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN G. HASBROUCK DDS
Provider Business Mailing Address
First Line : 9640 FEATHERWOOD LN
Second Line :
City : CENTERVILLE
State : OH
Zip : 45458
Country : US
Telephone Number : 937-885-3522
Fax Number :
Provider Business Practice Location Address
First Line : 6651 CENTERVILLE BUSINESS PKWY
Second Line :
City : CENTERVILLE FINANCE
State : OH
Zip : 45459-2689
Country : US
Telephone Number : 937-312-0044
Fax Number : 937-312-0088
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 07/08/2007

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Directions to “ DR. JOHN G. HASBROUCK DDS” Practice Location

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