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Individual

DR. LAURENCE MATTHEW HAGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.M.D.

Contact information

Practice address
400 PASS RD, GULFPORT, MS 39507-2901
(228) 864-3416
(228) 864-5437
Mailing address
400 PASS RD, GULFPORT, MS 39507-2901
(228) 864-3416
(228) 864-5437

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3271-03
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
06456021
MS
Enumeration date
01/04/2007
Last updated
07/08/2007
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