Healthcare Provider Details

I. General information

NPI: 1194989749
Provider Name (Legal Business Name): TIMOTHY LUKE HAGLER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27290 HWY 86
GORDO AL
35466
US

IV. Provider business mailing address

PO BOX 1135
GORDO AL
35466
US

V. Phone/Fax

Practice location:
  • Phone: 205-364-7777
  • Fax:
Mailing address:
  • Phone: 205-364-7777
  • Fax: 205-364-0633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5234
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5634
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: