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General NPI Number Information
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NPI Number | 1992097257
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Entity Type | Organization
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Legal Business Name | WILLIAM J. HAGERTY DENTAL ASSOCIATES LLC
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Dates
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Enumeration Date | 05/05/2011
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Last Update Date | 05/05/2011
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Provider Practice Location Address
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Address Line | 303 N. MAIN ST. SUITE 103
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City | CENTERVILLE
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State | OH
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Zip | 45459-2565
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Country | US
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Telephone | 937-433-6903
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Fax |
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Provider Business Mailing Address
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Address Line | 7058 CORPORATE WAY SUITE 1
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City | DAYTON
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State | OH
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Zip | 45459-4295
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Country | US
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Telephone | 937-433-8303
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PENNY A ROGERS
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Credential |
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Telephone | 937-433-8303
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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 | 16938
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License Number State | OH
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