Individual
CRYSTAL C HAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
449 CAPP HARLAN ROAD, TOMPKINSVILLE, KY 42167-0188
(270) 487-0017
Mailing address
PO BOX 188, 449 CAPP HARLAN ROAD, TOMPKINSVILLE, KY 42167-0188
(270) 487-0017
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6768
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0176688
BLUE CROSS BLUE SHIELD
TN
01
—
829583
UNITED CONCORDIA
—
Enumeration date
02/27/2007
Last updated
07/08/2007
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