Healthcare Provider Details

I. General information

NPI: 1497842264
Provider Name (Legal Business Name): DAVID M HAGEL D.D.S., P.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23515 NE NOVELTY HILL RD #209
REDMOND WA
98053-1996
US

IV. Provider business mailing address

23515 NE NOVELTY HILL RD #209
REDMOND WA
98053-1996
US

V. Phone/Fax

Practice location:
  • Phone: 425-898-7780
  • Fax: 425-898-1310
Mailing address:
  • Phone: 425-898-7780
  • Fax: 425-898-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5258
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: