Provider Demographics
NPI:1104997477
Name:HAGER, RONALD CHARLES (DDS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:CHARLES
Last Name:HAGER
Suffix:
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 1:1501 W STOUT ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-5001
Mailing Address - Country:US
Mailing Address - Phone:715-236-8900
Mailing Address - Fax:715-236-7907
Practice Address - Street 1:1501 W STOUT ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-5001
Practice Address - Country:US
Practice Address - Phone:715-236-8900
Practice Address - Fax:715-236-7907
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50007750151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery