C. Edward Hagan, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7053 Issued in GA

Practice address

112 Clifford Ave
Sylvania, GA 30467-2012

Phone

(912) 564-7107

Fax

(912) 564-9349

NPI assigned

Aug 1, 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clifford Avenue Dental LLC

  dba Screven Dental

  • General Practice Dentistry
  • Sylvania, GA
  • NPI 1831954304
  NPD (past)
• Screven Dental

  • Dental Clinic/Center
  • Sylvania, GA
  • NPI 1821501040
  NPD (past)

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306853718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 MORNINGSIDE DR",
            "city": "SYLVANIA",
            "state": "GA",
            "postal_code": "304678515",
            "telephone_number": "912-564-2173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 CLIFFORD AVE",
            "city": "SYLVANIA",
            "state": "GA",
            "postal_code": "304672012",
            "telephone_number": "912-564-7107",
            "fax_number": "912-564-9349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGAN",
        "first_name": "C.",
        "middle_name": "EDWARD",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "7053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00046373A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gerdie and Louise PCH
• Gerdie and Louise Personal Care Home, L.L.C.
• Graceful Carriers, LLC.
• Mylissa McGaha Gregory, PA-C
• Christopher Lee Griner, PHARMD
• Healthstat on-Site Clinic-Milliken Longleaf
• Margaret Ann Hollingsworth, RN
• Valarie Hopkins
• Miranda Jackson
• Sharon A. Jacobs, LPN

• General Practice Dentistry in Sylvania, GA
• Providers in Sylvania, GA by specialty
• General Practice Dentistry in Georgia

• 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.