Active NPI
Melanie Lynn Hageman, DDS
- Pediatric Dentistry
- Fargo, ND
National Provider Identifier
1659622173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 2243
- Practice address
- 3142 49TH St S
Fargo, ND 58104-4450 - Phone
- (701) 293-6999
- Fax
- (701) 293-6999
- NPI assigned
- Sep 24, 2012
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 2243 | ND | Primary |
Addresses
Primary practice location
3142 49TH St S
Fargo, ND 58104-4450
Mailing address
517 18TH Ave E
West Fargo, ND 58078-4224
Phone (701) 238-8521
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2243 | ND | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Dentistry LTD | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dentist
- Fargo, ND
- NPI 1487882718
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489449600000",
"number": "1659622173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "517 18TH AVE E",
"city": "WEST FARGO",
"state": "ND",
"postal_code": "580784224",
"telephone_number": "701-238-8521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3142 49TH ST S",
"city": "FARGO",
"state": "ND",
"postal_code": "581044450",
"telephone_number": "701-293-6999",
"fax_number": "701-293-6999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGEMAN",
"first_name": "MELANIE",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-24",
"last_updated": "2017-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "ND",
"license": "2243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.