Justin Lee Hagen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12277 Issued in MN

Practice address

1150 Hazeltine Blvd
Chaska, MN 55318-1004

Phone

(952) 361-0777

Fax

(952) 361-6729

NPI assigned

Jan 3, 2007

Last updated

Jun 29, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498694400000",
    "number": "1184781528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 HAZELTINE BLVD",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "55318",
            "telephone_number": "952-361-0777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 HAZELTINE BLVD",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "553181004",
            "telephone_number": "952-361-0777",
            "fax_number": "952-361-6729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEN",
        "first_name": "JUSTIN",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2017-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "698845800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grows PLLC
• Riley Paige Guldberg
• Theresa L Gunderson, PHD
• Nik Gustafson, ATC
• Elizabeth Haag, MS, OTR/L
• Jennifer Joy Hall, CPM
• Lucas Joel Hammell, D.O.
• William James Hammes, MD
• Jennifer L Hansen, MPT
• Holly Hanson, PSY.D., LP

• General Practice Dentistry in Chaska, MN
• Providers in Chaska, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2017; 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.