MEDICARE: DR. JAMES ERIC LAVESPERE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	4708	LA

General Provider Information

NPI Number	:	1619192762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ERIC LAVESPERE DDS

Provider Business Mailing Address
First Line	:	2800 KILPATRICK BLVD
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-5139
Country	:	US
Telephone Number	:	318-855-5021
Fax Number	:	318-855-5025

Provider Business Practice Location Address
First Line	:	2800 KILPATRICK BLVD
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-5139
Country	:	US
Telephone Number	:	318-855-5021
Fax Number	:	318-855-5025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/18/2013

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