Provider Demographics
NPI:1285946855
Name:HAGERMAN, BROOKLYN RAE (DMD)
Entity type:Individual
Prefix:DR
First Name:BROOKLYN
Middle Name:RAE
Last Name:HAGERMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 N SAIDE LN
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-4503
Mailing Address - Country:US
Mailing Address - Phone:623-810-0341
Mailing Address - Fax:623-466-6737
Practice Address - Street 1:1300 S WATSON RD STE A-100
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-6303
Practice Address - Country:US
Practice Address - Phone:623-386-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-11
Last Update Date:2010-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice