Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 19712 | OH |
NPI | 1063602175 |
---|---|
Provider Name | Mr. Burton Louis Hagler |
First Address | Xenia, OH 45385-1622 |
Second Address | Xenia, OH 45385-1622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2007 |
Last Update Date | 26/07/2007 |