Healthcare Provider Details

I. General information

NPI: 1366442774
Provider Name (Legal Business Name): C. STEVEN HAGLER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N HOLLY ST
CANBY OR
97013-3739
US

IV. Provider business mailing address

2330 E MADRONA LN
CANBY OR
97013-2522
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD5530
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: