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General NPI Number Information
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NPI Number | 1174616932
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Entity Type | Organization
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Legal Business Name | WILLIAM J. HAGERTY DDS INC.
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7058 CORPORATE WAY SUITE #2
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City | CENTERVILLE
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State | OH
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Zip | 45459
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Country | US
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Telephone | 937-434-3987
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Fax | 937-434-2646
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Provider Business Mailing Address
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Address Line | 7058 CORPORATE WAY SUITE #2
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City | CENTERVILLE
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State | OH
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Zip | 45459
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Country | US
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Telephone | 937-434-3987
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Fax | 937-434-2646
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | NEVADA D ENDICOTT
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Credential |
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Telephone | 937-837-1888
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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 | 30016938
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License Number State | OH
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