MEDICARE: RONALD J HAGGERTY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2119	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063515302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD J HAGGERTY DDS

Provider Business Mailing Address
First Line	:	PO BOX 1060
Second Line	:
City	:	FORT ASHBY
State	:	WV
Zip	:	26719-1060
Country	:	US
Telephone Number	:	304-298-3501
Fax Number	:	304-298-3406

Provider Business Practice Location Address
First Line	:	LINCOLN STREET
Second Line	:
City	:	FORT ASHBY
State	:	WV
Zip	:	26719
Country	:	US
Telephone Number	:	304-298-3501
Fax Number	:	304-298-3406

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	07/08/2007

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