Healthcare Provider Details

I. General information

NPI: 1366413791
Provider Name (Legal Business Name): FRED V HARGIS JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N MILL ST
MINNEAPOLIS KS
67467
US

IV. Provider business mailing address

311 N MILL ST
MINNEAPOLIS KS
67467
US

V. Phone/Fax

Practice location:
  • Phone: 785-392-2194
  • Fax: 785-392-3231
Mailing address:
  • Phone: 785-392-2194
  • Fax: 785-392-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4835
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: