Individual
DR. JOHN MASON HACKENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
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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