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General NPI Number Information
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NPI Number | 1306853718
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Entity Type | Individual
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Provider Name | C. EDWARD HAGAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 112 CLIFFORD AVE
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City | SYLVANIA
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State | GA
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Zip | 30467-2012
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Country | US
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Telephone | 912-564-7107
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Fax | 912-564-9349
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Provider Business Mailing Address
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Address Line | 114 MORNINGSIDE DR
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City | SYLVANIA
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State | GA
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Zip | 30467-8515
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Country | US
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Telephone | 912-564-2173
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7053
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License Number State | GA
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