Carlton Bruce Hagstrom, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19A15870 Issued in IL

Practice address

208 S US Highway 12
Fox Lake, IL 60020-1928

Phone

(847) 587-5400

Fax

(847) 587-5400

NPI assigned

Jul 26, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144243585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 S US HIGHWAY 12",
            "city": "FOX LAKE",
            "state": "IL",
            "postal_code": "600201928",
            "telephone_number": "847-587-5400",
            "fax_number": "847-587-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 S US HIGHWAY 12",
            "city": "FOX LAKE",
            "state": "IL",
            "postal_code": "600201928",
            "telephone_number": "847-587-5400",
            "fax_number": "847-587-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGSTROM",
        "first_name": "CARLTON",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19A15870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Altijana Gallup, PHARMD
• Mrugendra M. Gandhi, M.D.
• Eva Angelica Garcia, LSW
• Grant Community High School District 124
• Lizbeth Guzman
• Mackenzie Hansen
• Healthcare Associates (Lakeside Chiropractic)
• Patryk Janowski
• Nicholas Kaczkowski, PT, DPT, MS
• Taylor Kaether, MS, LCPC

• General Practice Dentistry in Fox Lake, IL
• Providers in Fox Lake, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.