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General NPI Number Information
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NPI Number | 1669907317
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Entity Type | Organization
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Legal Business Name | ROBERT R HAGLUND JR DMD, MDS,II,PA
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 8912 BLAKENEY PROFESSIONAL DR SUITE 300
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City | CHARLOTTE
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State | NC
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Zip | 28277-6734
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Country | US
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Telephone | 980-833-1214
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Fax | 980-833-1637
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Provider Business Mailing Address
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Address Line | 8912 BLAKENEY PROFESSIONAL DRIVE SUITE 300
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City | CHARLOTTE
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State | NC
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Zip | 28277-6734
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Country | US
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Telephone | 980-833-1214
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Fax | 980-833-1637
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT R HAGLUND
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Credential | DMD,MDS,II,PA
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Telephone | 980-833-1214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 7727
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License Number State | NC
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