Healthcare Provider Details

I. General information

NPI: 1689697328
Provider Name (Legal Business Name): PAUL G HAGEMANN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 5TH AVE N
HURLEY WI
54534-1209
US

IV. Provider business mailing address

6747 W KIMBALL DR
HURLEY WI
54534-9054
US

V. Phone/Fax

Practice location:
  • Phone: 715-561-3291
  • Fax: 715-561-4377
Mailing address:
  • Phone: 715-561-2817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5001670
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: