MEDICARE: HAGE THIRD DENTAL PROFESSIONAL CORPORATION

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

General Provider Information

NPI Number	:	1689547531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAGE THIRD DENTAL PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2451 JAMACHA ROAD
Second Line	:	SUITE 104
City	:	EL CAJON
State	:	CA
Zip	:	92019-4324
Country	:	US
Telephone Number	:	619-444-0500
Fax Number	:	619-444-2803

Provider Business Practice Location Address
First Line	:	2451 JAMACHA ROAD
Second Line	:	SUITE 104
City	:	EL CAJON
State	:	CA
Zip	:	92019-4324
Country	:	US
Telephone Number	:	619-444-0500
Fax Number	:	619-444-2803

Authorized Official
Title or Position	:	CEO
Name	:	ARMIN HAGE
Credential	:	D.D.S
Telephone Number	:	619-444-0500

Provider Enumeration Date	:	09/26/2025
Last Update Date	:	09/26/2025

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