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C. EDWARD HAGAN D.D.S.

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1306853718

Individual Registrant:
 C. EDWARD HAGAN D.D.S.
Gender: M
Sole Proprietor

Location and contact information for practice:
112 CLIFFORD AVE  SYLVANIA, GA 30467-2012 US
Tel: 912-564-7107  Fax: 912-564-9349

Contact information for business:
114 MORNINGSIDE DR  SYLVANIA, GA 30467-8515 US
Tel: 912-564-2173  Fax: --

Registration Information:
NPI: 1306853718
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
GA7053

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
00046373AGA05




HEALTH CARE JOBS GA - Page 1



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