Individual
DR. DAVID JEROME HAGSTROM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2112 VIKING DR NW, ROCHESTER, MN 55901-3522
(507) 288-1744
(507) 292-5776
Mailing address
2112 VIKING DR NW, ROCHESTER, MN 55901-3522
(507) 288-1744
(507) 292-5776
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11449
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39492MA
MN BP
MN
01
—
39492MA
BCBS
—
01
—
5242464
MN ID
—
01
—
918158000
MEDICAL ASSISTANCE
MN
Enumeration date
11/10/2005
Last updated
07/08/2007
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