Active NPI
Richard J Hagstrom, DDS
- Dentist
- La Mesa, CA
National Provider Identifier
1316057367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 35401
- Practice address
- 8923 La Mesa Blvd
La Mesa, CA 91941-4056 - Phone
- (619) 465-5252
- Fax
- (619) 462-8222
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 35401 | CA | Primary |
Addresses
Primary practice location
8923 La Mesa Blvd
La Mesa, CA 91941-4056
Mailing address
8923 La Mesa Blvd
La Mesa, CA 91941-4056
Phone (619) 465-5252
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170830001327 | CA | Order and Referring Only - Dentist | 7810260643 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316057367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8923 LA MESA BLVD",
"city": "LA MESA",
"state": "CA",
"postal_code": "919414056",
"telephone_number": "619-465-5252",
"fax_number": "619-462-8222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8923 LA MESA BLVD",
"city": "LA MESA",
"state": "CA",
"postal_code": "919414056",
"telephone_number": "619-465-5252",
"fax_number": "619-462-8222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGSTROM",
"first_name": "RICHARD",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "35401",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Mesa, CA
Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.