Individual
C. EDWARD HAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
112 CLIFFORD AVE, SYLVANIA, GA 30467-2012
(912) 564-7107
(912) 564-9349
Mailing address
114 MORNINGSIDE DR, SYLVANIA, GA 30467-8515
(912) 564-2173
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7053
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00046373A
—
GA
Enumeration date
08/01/2006
Last updated
07/08/2007
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