Provider Demographics
NPI:1316299175
Name:HAGER, JEANETTE TRUONG (DDS)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:TRUONG
Last Name:HAGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 SCOTT BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-5255
Mailing Address - Country:US
Mailing Address - Phone:408-244-3629
Mailing Address - Fax:408-244-7137
Practice Address - Street 1:885 SCOTT BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-5255
Practice Address - Country:US
Practice Address - Phone:408-244-3629
Practice Address - Fax:408-244-7137
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice