MEDICARE: MARINA HAGENS 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
1	122300000X	Dentist	DN015342	GA

General Provider Information

NPI Number	:	1811434970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA HAGENS DDS

Provider Business Mailing Address
First Line	:	155 TRADERS WAY STE 400
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-4300
Country	:	US
Telephone Number	:	912-348-3155
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 TRADERS WAY STE 400
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-4300
Country	:	US
Telephone Number	:	912-348-3155
Fax Number	:	912-348-3153

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

Provider Enumeration Date	:	01/27/2017
Last Update Date	:	01/27/2017

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Directions to “ MARINA HAGENS DDS” Practice Location

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