Individual provider Active NPI

David C Haggard, DDS

  • General Practice Dentistry
  • Lake Forest, CA
National Provider Identifier
1396915641
Registry record updated Mar 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
32843 Issued in CA
Practice address
21991 El Toro Rd
Lake Forest, CA 92630-6518
Phone
(949) 380-7788
NPI assigned
Mar 3, 2008
Last updated
Mar 3, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 3, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 32843 CA Primary

Addresses

Primary practice location

21991 El Toro Rd
Lake Forest, CA 92630-6518

Mailing address

21991 El Toro Rd
Lake Forest, CA 92630-6518
Phone (949) 380-7788

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171114000878 CA Order and Referring Only - DentistPractitioner - Dentist 6709142409

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
32843CAMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1204502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204502400000",
    "number": "1396915641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21991 EL TORO RD",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926306518",
            "telephone_number": "949-380-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21991 EL TORO RD",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926306518",
            "telephone_number": "949-380-7788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGGARD",
        "first_name": "DAVID",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-03",
        "last_updated": "2008-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "32843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, CA

Sources for this page

Verify at the official NPI Registry.