Provider Demographics
NPI:1306942081
Name:KAGY, DAVID M (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:KAGY
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:PO BOX 457
Mailing Address - Street 2:26 COOK DR
Mailing Address - City:ATTICA
Mailing Address - State:OH
Mailing Address - Zip Code:44807
Mailing Address - Country:US
Mailing Address - Phone:419-426-4892
Mailing Address - Fax:419-426-4892
Practice Address - Street 1:26 COOK DR
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:OH
Practice Address - Zip Code:44807-0457
Practice Address - Country:US
Practice Address - Phone:417-426-4892
Practice Address - Fax:419-426-4892
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30016180122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2226371Medicaid