Provider Demographics
NPI:1730350935
Name:JACOB D. HAGER, D.D.S., M.S., P.C.
Entity type:Organization
Organization Name:JACOB D. HAGER, D.D.S., M.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:405-636-1411
Mailing Address - Street 1:8203 S WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9451
Mailing Address - Country:US
Mailing Address - Phone:405-636-1411
Mailing Address - Fax:405-636-1197
Practice Address - Street 1:8203 S WALKER AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9451
Practice Address - Country:US
Practice Address - Phone:405-636-1411
Practice Address - Fax:405-636-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5718261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental