Healthcare Provider Details

I. General information

NPI: 1255422689
Provider Name (Legal Business Name): C STEVEN HAGLER DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N HOLLY ST
CANBY OR
97013
US

IV. Provider business mailing address

2330 E MADRONA LN
CANBY OR
97013
US

V. Phone/Fax

Practice location:
  • Phone: 503-266-1117
  • Fax: 503-266-9114
Mailing address:
  • Phone: 503-263-6305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD5530
License Number StateOR

VIII. Authorized Official

Name: C STEVEN HAGLER
Title or Position: OWNER PRESIDENT
Credential:
Phone: 503-263-6305