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General NPI Number Information
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NPI Number | 1730350935
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Entity Type | Organization
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Legal Business Name | JACOB D. HAGER, D.D.S., M.S., P.C.
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 8203 S WALKER AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-9451
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Country | US
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Telephone | 405-636-1411
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Fax | 405-636-1197
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Provider Business Mailing Address
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Address Line | 8203 S WALKER AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-9451
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Country | US
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Telephone | 405-636-1411
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Fax | 405-636-1197
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACOB DANIEL HAGER
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Credential | D.D.S., M.S.
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Telephone | 405-636-1411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5718
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License Number State | OK
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