Neil Bruce Hagen, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

021001074 Issued in IL

Practice address

676 N Saint Clair St Ste 2280
Chicago, IL 60611-2920

Phone

(312) 926-2929

Fax

(312) 926-3595

NPI assigned

Apr 19, 2007

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

Practice roles

Locations

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

• Chicago Oral & Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Chicago, IL
  • NPI 1366599748
  NPD (past) Authorized official
• Gregory P Thomas, DDS, MD,P.C.

  dba Chicago Oral & Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Chicago, IL
  • NPI 1326716390
  NPD

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594857600000",
    "number": "1376760363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 2280",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112920",
            "telephone_number": "312-926-2929",
            "fax_number": "312-926-3595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 2280",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112920",
            "telephone_number": "312-926-2929",
            "fax_number": "312-926-3595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEN",
        "first_name": "NEIL",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-19",
        "last_updated": "2020-07-16",
        "certification_date": "2020-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "021001074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colton Hageman, MD
• Donald Hagen III, PHARMD
• Eric Michael Hagen, DMD
• Jenna L Hagen, CCLS
• Laura Hagen, LMFT
• Mira Elizabeth Hager, PA
• Matthew R Hagerman, MD
• Mark Hagerty
• Rachel Marie Hagfors, LCPC
• Elizabeth Marie Haggerty, MD

• Oral and Maxillofacial Surgery (Dentist) in Chicago, IL
• Providers in Chicago, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.

Verify at the official NPI Registry.