MEDICARE: DR. CHRISTOPHER JOHN HAGGERTY DDS, MD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	S-350	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14777625	OTHER	MO	CAREINGTON
2	273850017	OTHER	MO	DELTA OF MISSOURI
3	002514127	OTHER	MO	UNITED CONCORDIA
4	273850017	OTHER	MO	GUARDIAN
5	1700482249	OTHER	MO	GEHA
6	273850017	OTHER	MO	METLIFE
7	273850017	OTHER	MO	DELTA OF KANSAS
8	273850017	OTHER	MO	HUMANA
9	2002013152	OTHER	MO	CIGNA
10	40397051	OTHER	MO	BLUE CROSS BLUE SHEILD OF KANSAS CITY

General Provider Information

NPI Number	:	1629244959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER JOHN HAGGERTY DDS, MD

Provider Business Mailing Address
First Line	:	3600 NE RALPH POWELL RD
Second Line	:	SUITE D
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-2369
Country	:	US
Telephone Number	:	816-554-8300
Fax Number	:	816-554-8303

Provider Business Practice Location Address
First Line	:	3600 NE RALPH POWELL RD
Second Line	:	SUITE D
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-2369
Country	:	US
Telephone Number	:	816-554-8300
Fax Number	:	816-554-8303

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

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	03/10/2011

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