Michael Theodore Hagley, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8842 Issued in MN

Practice address

220 SE 21St St
Grand Rapids, MN 55744-4268

Phone

(218) 326-3438

Fax

(218) 327-1475

NPI assigned

Aug 16, 2006

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

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.

Opted out of Medicare

Yes, effective Jun 20, 2018 through Jun 20, 2028

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Grand Rapids Dental Care LLC

  • Dental Clinic/Center
  • Grand Rapids, MN
  • NPI 1659906204
  NPD (past)
• Northwoods Dentistry PLLC

  • General Practice Dentistry
  • Grand Rapids, MN
  • NPI 1730792334
  NPD (past)

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972616605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 SE 21ST ST",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "55744",
            "telephone_number": "218-326-3438",
            "fax_number": "218-327-1475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 SE 21ST ST",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557444268",
            "telephone_number": "218-326-3438",
            "fax_number": "218-327-1475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGLEY",
        "first_name": "MICHAEL",
        "middle_name": "THEODORE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "8842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalie Jane Gustafson, NP
• Bruce Haag, LADC
• Theresa Louise Hachey, LADC
• Kristina Anne Haden, APRN, CNP
• Lindsey Hagen, LADC
• Jody J Hahn, OTR
• Heidi Halker
• Erick Michael Hallie, D.D.S.
• Valerie Halverson, R.PH.
• Wade Daniel Halvorsen

• General Practice Dentistry in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• General Practice Dentistry in Minnesota

• 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.