Hagstrom, David Jerome

Hagstrom, David Jerome is an individual health care provider with primary practice located at 2112 Viking Dr Nw , Rochester MN 55901-3522. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Hagstrom, David Jerome can be contacted via phone (507) 288-1744.

Contact Information

Primary practice address
2112 Viking Dr Nw Rochester MN 55901-3522
Phone: (507) 288-1744
Fax: (507) 292-5776
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X D11449 Minnesota

Profile Details

NPI number 1639150006
LBN Legal business name Hagstrom, David Jerome
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 10th, 2005
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639150006 NPPES
Other 39492MA BCBS
Other 5242464 BCBS
Other 39492MA BCBS
Other 918158000 BCBS

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