Provider Demographics
NPI:1033780713
Name:HAGERTY, SARAH MARILYN (DMD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MARILYN
Last Name:HAGERTY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MARILYN
Other - Last Name:FIDELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2831 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-7430
Mailing Address - Country:US
Mailing Address - Phone:407-590-7803
Mailing Address - Fax:
Practice Address - Street 1:7885 NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-6640
Practice Address - Country:US
Practice Address - Phone:904-783-1633
Practice Address - Fax:904-783-2046
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist