Provider Demographics
NPI:1861605867
Name:HAGGERTY, EDWARD RICHARD JR (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:RICHARD
Last Name:HAGGERTY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 NW PARK LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1847
Mailing Address - Country:US
Mailing Address - Phone:816-525-1655
Mailing Address - Fax:816-524-7800
Practice Address - Street 1:818 NW PARK LN
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-1847
Practice Address - Country:US
Practice Address - Phone:816-525-1655
Practice Address - Fax:816-524-7800
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12192122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist