Healthcare Provider Details

I. General information

NPI: 1235880048
Provider Name (Legal Business Name): EGH DENTAL ARTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PINE WEST PLZ STE 516
ALBANY NY
12205-5593
US

IV. Provider business mailing address

5 PINE WEST PLZ STE 516
ALBANY NY
12205-5593
US

V. Phone/Fax

Practice location:
  • Phone: 518-456-7673
  • Fax: 518-456-8369
Mailing address:
  • Phone: 518-456-7673
  • Fax: 518-456-8369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIK G HAGEMAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 518-456-7673