Provider Demographics
NPI:1982699104
Name:HAGERTY & MAZZOLA D.D.S., INC
Entity type:Organization
Organization Name:HAGERTY & MAZZOLA D.D.S., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HAGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-837-1888
Mailing Address - Street 1:321 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-3507
Mailing Address - Country:US
Mailing Address - Phone:937-837-1888
Mailing Address - Fax:937-837-1886
Practice Address - Street 1:18 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-2843
Practice Address - Country:US
Practice Address - Phone:937-866-8484
Practice Address - Fax:937-866-8981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH192301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty