Organization
KEVIN P. HAGERTY DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN PATRICK HAGERTY DMD (OWNER)
(401) 884-4874
Entity
Organization
Contact information
Practice address
61 CEDAR AVE UNIT 5, EAST GREENWICH, RI 02818-3190
(401) 884-4874
(401) 884-4928
Mailing address
61 CEDAR AVENUE, #5, EAST GREENWICH, RI 02818
(401) 884-4874
(401) 884-4928
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2155
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8048-6
BLUE CROSS RI DENTAL
RI
05
—
KH00257
—
RI
Enumeration date
05/12/2009
Last updated
05/12/2009
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