MEDICARE: DR. M. JOHNSON HAGOOD 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	DN15668	FL

General Provider Information

NPI Number	:	1639295363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. M. JOHNSON HAGOOD D.D.S.

Provider Business Mailing Address
First Line	:	886 DAHLIA LN
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32963-4914
Country	:	US
Telephone Number	:	772-567-2237
Fax Number	:	772-567-1052

Provider Business Practice Location Address
First Line	:	886 DAHLIA LN
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32963-4914
Country	:	US
Telephone Number	:	772-567-2237
Fax Number	:	772-567-1052

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	08/27/2025

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