Individual
DR. JUSTIN LEE HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1150 HAZELTINE BLVD, CHASKA, MN 55318-1004
(952) 361-0777
(952) 361-6729
Mailing address
1150 HAZELTINE BLVD, CHASKA, MN 55318
(952) 361-0777
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12277
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
698845800
—
MN
Enumeration date
01/03/2007
Last updated
06/29/2017
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