MEDICARE: BURTON L HAGLER DDS INC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	19712	OH

General Provider Information

NPI Number	:	1265501654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURTON L HAGLER DDS INC

Provider Business Mailing Address
First Line	:	1202 NORTH MONROE DRIVE
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-1622
Country	:	US
Telephone Number	:	937-372-9279
Fax Number	:	937-374-0334

Provider Business Practice Location Address
First Line	:	1202 NORTH MONROE DRIVE
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-1622
Country	:	US
Telephone Number	:	937-372-9279
Fax Number	:	937-374-0334

Authorized Official
Title or Position	:	DR OWNER
Name	:	DR. BURTON LOUIS HAGLER
Credential	:	DDS MS
Telephone Number	:	937-372-9279

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	08/22/2020

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