Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN015083 | GA |
NPI | 1063745479 |
---|---|
Provider Name | Dr. Loy Adam Hagan |
First Address | Savannah, GA 31411-2810 |
Second Address | Savannah, GA 31411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2009 |
Last Update Date | 11/12/2015 |