Healthcare Provider Details

I. General information

NPI: 1730350935
Provider Name (Legal Business Name): JACOB D. HAGER, D.D.S., M.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

8203 S WALKER AVE
OKLAHOMA CITY OK
73139-9451
US

IV. Provider business mailing address

8203 S WALKER AVE
OKLAHOMA CITY OK
73139-9451
US

V. Phone/Fax

Practice location:
  • Phone: 405-636-1411
  • Fax: 405-636-1197
Mailing address:
  • Phone: 405-636-1411
  • Fax: 405-636-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number5718
License Number StateOK

VIII. Authorized Official

Name: DR. JACOB DANIEL HAGER
Title or Position: PRESIDENT
Credential: D.D.S., M.S.
Phone: 405-636-1411