Provider Demographics
NPI:1144629676
Name:HAGGERTY, COLE
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:
Last Name:HAGGERTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 REDDING RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-2550
Mailing Address - Country:US
Mailing Address - Phone:859-333-2683
Mailing Address - Fax:
Practice Address - Street 1:431 REDDING RD STE 110
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-2550
Practice Address - Country:US
Practice Address - Phone:859-266-2149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 21110122300000X
KY9523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist