| David J. Hagstrom Llc | |
|
2112 Viking Dr Nw Rochester MN 55901-3522 | |
| (507) 288-1744 | |
| (507) 292-5776 |
| Full Name | David J. Hagstrom Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2112 Viking Dr Nw, Rochester, Minnesota |
| Authorized Official Name and Position | David Jerome Hagstrom (OWNER) |
| Authorized Official Contact | 5072881744 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| David J. Hagstrom Llc 2112 Viking Dr Nw Rochester MN 55901-3522 Ph: (507) 288-1744 | David J. Hagstrom Llc 2112 Viking Dr Nw Rochester MN 55901-3522 Ph: (507) 288-1744 |
| NPI Number | 1225196363 |
|---|---|
| Provider Enumeration Date | 12/04/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225196363 | NPI | - | NPPES |
| 39492MA | Other | MN | BLUE CROSS BLUE SHIELD |
| 9175780 | Other | MN | DORAL DENTAL IDENTIFIER |
| D11449 | Other | MN | LICENSE NUMBER |
| 1348318 | Other | MN | TRI CARE ID NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D11449 (Minnesota) | Primary |
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