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General NPI Number Information
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NPI Number | 1073819884
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Entity Type | Organization
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Legal Business Name | GARY E HAGEN
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Dates
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Enumeration Date | 01/27/2011
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 90 MADISON ST SUITE 406
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City | DENVER
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State | CO
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Zip | 80206-5418
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Country | US
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Telephone | 303-393-6006
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Fax | 303-377-5173
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Provider Business Mailing Address
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Address Line | 90 MADISON ST SUITE 406
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City | DENVER
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State | CO
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Zip | 80206-5418
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Country | US
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Telephone | 303-393-6006
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Fax | 303-377-5173
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARY EDWARD HAGEN
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Credential | DDS
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Telephone | 303-393-6006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 104680
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License Number State | CO
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