# KEVIN P. HAGERTY DMD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518191170
- **Authorized official:** DR. KEVIN PATRICK HAGERTY DMD (OWNER)
- **Authorized official phone:** (401) 884-4874

## Contact information

- **Practice address:** 61 CEDAR AVE UNIT 5, EAST GREENWICH, RI 02818-3190
- **Practice address phone:** (401) 884-4874
- **Practice address fax:** (401) 884-4928
- **Mailing address:** 61 CEDAR AVENUE, \#5, EAST GREENWICH, RI 02818
- **Mailing address phone:** (401) 884-4874
- **Mailing address fax:** (401) 884-4928

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2155 | RI | Yes |

## Other

- **Enumeration date:** 05/12/2009
- **Last updated:** 05/12/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 8048-6 | BLUE CROSS RI DENTAL | RI |
| 05 | — | KH00257 | — | RI |