Organization
HAGE FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURENCE MATTHEW HAGE D.M.D. (OWNER)
(228) 864-3416
Entity
Organization
Contact information
Practice address
400 PASS RD, GULFPORT, MS 39507-2901
(228) 864-3416
Mailing address
400 PASS RD, GULFPORT, MS 39507-2901
(228) 864-3416
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3271-03
MS
Other
Enumeration date
07/10/2007
Last updated
07/10/2007
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