Provider Demographics
NPI:1932581501
Name:NGUYEN-HAGEMAN, PHOEBE (DDS)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:
Last Name:NGUYEN-HAGEMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PHUC
Other - Middle Name:THI HONG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:131 WESTCHESTER DR N.
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054
Mailing Address - Country:US
Mailing Address - Phone:716-248-6040
Mailing Address - Fax:
Practice Address - Street 1:74 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054
Practice Address - Country:US
Practice Address - Phone:518-439-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0587101223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice