DAVID J. HAGSTROM LLC (NPI# 1225196363) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225196363 |
| Entity Type | Organization |
| Organization Name | DAVID J. HAGSTROM LLC |
| Practice Address |
2112 Viking Dr Nw Rochester MN 55901-3522 |
| Practice Telephone | 5072881744 |
| Practice Fax Number | 5072925776 |
| Mailing Telephone | 5072881744 |
| Mailing Fax Number | 5072925776 |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. DAVID JEROME HAGSTROM (OWNER) |
| Authorized Official Telephone | 5072881744 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
D11449 | MN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | DORAL DENTAL IDENTIFIER | 9175780 | 01 |
| MN | LICENSE NUMBER | D11449 | 01 |
| MN | TRI CARE ID NUMBER | 1348318 | 01 |
| MN | BLUE CROSS BLUE SHIELD | 39492MA | 01 |
| Street Address |
2112 VIKING DR NW |
| City | ROCHESTER |
| State | MN |
| Zip Code | 55901-3522 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407844780 | Thomas Lyman Sitzer | Dentist | 2112 Viking Dr Nw, Valhalla Dental Building, Rochester, MN 55901-3522 | 2005-10-11 |
| 1396278503 | Seong Woo Lee | Dentist | 2112 Viking Dr Nw, Rochester, MN 55901-3522 | 2017-04-05 |
| 1235513755 | Zumbro Family Dental | Dentist | 2112 Viking Dr Nw, Suite G, Rochester, MN 55901-3522 | 2015-07-14 |
| 1730586579 | Advanced Periodontics & Implants Pllc | Dentist | 2112 Viking Dr Nw, Rochester, MN 55901-3522 | 2014-11-21 |
| 1720369812 | Thomas L. Sitzer, D.d.s., P.a. | Dentist | 2112 Viking Dr Nw, Valhalla Dental Building, Rochester, MN 55901-3522 | 2011-09-01 |
| 1629300298 | Marko Kamel Dds Pa | Health Maintenance Organization | 2112 Viking Dr Nw, Suite E, Rochester, MN 55901-3522 | 2010-02-08 |
| 1861693491 | Bryan Mark Recker | Dentist | 2112 Viking Dr Nw, Rochester, MN 55901-3522 | 2007-05-30 |
| 1285786822 | Vincent Monroe Hollaren | Dentist | 2112 Viking Dr Nw, Rochester, MN 55901-3522 | 2007-01-16 |
| 1801968839 | Anthony Charles Michelich | Dentist | 2112 Viking Dr Nw, Rochester, MN 55901-3522 | 2006-11-14 |
| 1740359546 | Periodontal Specialists, Pa | Dentist | 2112 Viking Dr Nw, Rochester, MN 55901-3522 | 2006-11-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417554627 | Austin Montgomery Gray | Chiropractor | 4229 West Frontage Rd Nw, Suite 4, Rochester, MN 55901 | 2020-10-01 |
| 1497303150 | Tatenda Valentine Rudziva | Nurse Practitioner | 2989 315 Elton Hills Drive Nw, Suite 201, Rochester, MN 55901 | 2019-08-27 |
| 1629566872 | Juan Simon Rico Mesa | Student in an Organized Health Care Education/Training Program | 4502 Medical Drive, San Antonio, 78229, San Antonio, TX 55901 | 2018-04-24 |
| 1336658277 | Minnesota Teen Challenge | Exclusive Provider Organization | 1542 Assisi Drive Nw, Rochester, MN 55901 | 2017-09-22 |
| 1235648270 | Mariah Adanene | Registered Nurse | 915 41st Street Nw, Rochester, MN 55901 | 2017-09-21 |
| 1912420639 | Anna Maria Schuman | Speech-Language Pathologist | 2746 Superior Drive Nw, Suite Number 150, Rochester, MN 55901 | 2017-07-25 |
| 1871013870 | Rhonda Keith | Counselor | 602 11th Avenue Nw #300, Rochester, MN 55901 | 2017-06-21 |
| 1548794316 | Trevor Kindle | Ophthalmology | 200 1st Ave Nw, Rochester, MN 55901 | 2017-04-18 |
| 1659810844 | Rx Team Home Health Care LLC | Home Health | 1027 7th St Nw Unit #204, Rochester, MN 55901 | 2017-02-21 |
| 1457713109 | Joshua Carter | Chiropractor | 3270 19th St Nw Ste 203, Rochester, MN 55901 | 2016-03-22 |
| Find all providers in zip 55901 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760091763 | Erie Canal Dental Pllc | Dentist | 91 Erie Canal Dr Ste A, Rochester, NY 14626-4603 | 2020-07-26 |
| 1891303962 | Bryson Sloan Rushing | Dentist | 18 3rd St Sw Ste 300, Rochester, MN 55902-3022 | 2020-07-15 |
| 1033777636 | Mindy D Dogmanits | Dentist | 1300 Jefferson Rd Ste 300, Rochester, NY 14623-3195 | 2019-05-30 |
| 1447814553 | Gilbert Frank Hernandez | Dentist | 1299 Portland Ave Ste 4, Rochester, NY 14621-2727 | 2019-04-24 |
| 1669935920 | Michael Delucia | Dentist | 2105 Dewey Ave, Rochester, NY 14615-2207 | 2019-04-12 |
| 1912460189 | Vincenzo Giuseppe Marino | Dentist | 550 Latona Rd Ste B100, Rochester, NY 14626-2723 | 2019-04-12 |
| 1699255307 | Urgent Dental Care, Pllc | Dentist | 1740 Culver Rd Lowr Suite, Rochester, NY 14609-3836 | 2018-08-21 |
| 1811488737 | Anthony Richard Mesolella | Dentist | 2081 W Ridge Rd Ste 204, Rochester, NY 14626 | 2018-05-26 |
| 1235637141 | Cornerstone Dental of Henrietta | Dentist | 2104 E. Henrietta Road, Rochester, NY 14623 | 2018-01-25 |
| 1710415039 | Abner O De Los Santos | Dentist | 120 Erie Canal Dr Ste 150, Rochester, NY 14626 | 2017-05-31 |
| Find all providers in ROCHESTER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.