Individual
DR. JOHN MASON HACKENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
29427 RYAN RD, WARREN, MI 48092-2203
(586) 755-9340
(586) 755-1081
Mailing address
29425 RYAN RD, WARREN, MI 48092-2203
(586) 755-9340
(586) 755-9341
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2901016237
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970E07680
BLUE CROSS PIN
MI
Enumeration date
05/23/2006
Last updated
07/24/2009
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