Healthcare Provider Details

I. General information

NPI: 1629244959
Provider Name (Legal Business Name): CHRISTOPHER JOHN HAGGERTY DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 NE RALPH POWELL RD SUITE D
LEES SUMMIT MO
64064-2369
US

IV. Provider business mailing address

3600 NE RALPH POWELL RD SUITE D
LEES SUMMIT MO
64064-2369
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-8300
  • Fax: 816-554-8303
Mailing address:
  • Phone: 816-554-8300
  • Fax: 816-554-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberS-350
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: