Provider Demographics
NPI:1568191955
Name:HAGOOD, MACKENZIE CHASE (DMD)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:CHASE
Last Name:HAGOOD
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 1:1390 CITY VIEW CTR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5530
Mailing Address - Country:US
Mailing Address - Phone:407-977-9990
Mailing Address - Fax:
Practice Address - Street 1:1390 CITY VIEW CTR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5530
Practice Address - Country:US
Practice Address - Phone:407-977-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10801122300000X
FLDN289541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist