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General NPI Number Information
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NPI Number | 1467917278
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Entity Type | Individual
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Provider Name | MICHAEL J HACKEN
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Gender | Male
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 51565 BITTERSWEET RD
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City | GRANGER
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State | IN
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Zip | 46530-8859
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Country | US
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Telephone | 574-277-1211
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Fax | 574-277-5812
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Provider Business Mailing Address
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Address Line | 51565 BITTERSWEET RD
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City | GRANGER
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State | IN
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Zip | 46530-8859
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Country | US
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Telephone | 574-277-1211
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Fax | 574-277-5812
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12012903A
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License Number State | IN
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