Active NPI
David J. Hagstrom LLC
- General Practice Dentistry
- Rochester, MN
National Provider Identifier
1225196363
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D11449
- Legal business name
- DAVID J. HAGSTROM LLC
- Practice address
- 2112 Viking Dr NW
Rochester, MN 55901-3522 - Phone
- (507) 288-1744
- Fax
- (507) 292-5776
- NPI assigned
- Dec 4, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. David Jerome Hagstrom, D.D.S.
- Title
- Owner
- Phone
- (507) 288-1744
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D11449 | MN | Primary |
Addresses
Primary practice location
2112 Viking Dr NW
Rochester, MN 55901-3522
Mailing address
2112 Viking Dr NW
Rochester, MN 55901-3522
Phone (507) 288-1744
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39492MA | Other | MN | BLUE CROSS BLUE SHIELD |
| 9175780 | Other | MN | DORAL DENTAL IDENTIFIER |
| D11449 | Other | MN | LICENSE NUMBER |
| 1348318 | Other | MN | TRI CARE ID NUMBER |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1225196363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2112 VIKING DR NW",
"city": "ROCHESTER",
"state": "MN",
"postal_code": "559013522",
"telephone_number": "507-288-1744",
"fax_number": "507-292-5776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2112 VIKING DR NW",
"city": "ROCHESTER",
"state": "MN",
"postal_code": "559013522",
"telephone_number": "507-288-1744",
"fax_number": "507-292-5776"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DAVID J. HAGSTROM LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-04",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "HAGSTROM",
"authorized_official_first_name": "DAVID",
"authorized_official_middle_name": "JEROME",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "507-288-1744",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "D.D.S."
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "D11449",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "39492MA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DORAL DENTAL IDENTIFIER",
"identifier": "9175780",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "D11449",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRI CARE ID NUMBER",
"identifier": "1348318",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rochester, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.