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Provider Information for 1780668996

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

KENNETH J. HAGEN JR. DDS

Gender: MALE

Individual NPI: 1780668996

Calendar   Last Updated:  2007-07-08
  Certification Date: 

Details

Name Value
NPI 1780668996
Enumeration Date 2005-12-01
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 2811 N 90TH ST
OMAHA, NE 68134-5707
United States

Phone: 402-391-0459 | Fax: 402-384-8888
View Map External Link
Primary Practice Address 2811 N 90TH ST
OMAHA, NE 68134-5707
United States

Phone: 402-391-0459 | Fax: 402-384-8888
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other BCBS PROVIDER ID NE 5807
Other UNITED CONCORDIA ID# NE 132485
MEDICAID NE 47063287713
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice NE 4646