MEDICARE: CLAIRE STAGG DDS PA

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	1223G0001X	General Practice Dentistry	DN0012078	FL

General Provider Information

NPI Number	:	1649391731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAIRE STAGG DDS PA

Provider Business Mailing Address
First Line	:	2120 HIGHWAY A1A
Second Line	:
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-4924
Country	:	US
Telephone Number	:	321-777-2797
Fax Number	:	321-777-6887

Provider Business Practice Location Address
First Line	:	2120 HIGHWAY A1A
Second Line	:
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-4924
Country	:	US
Telephone Number	:	321-777-2797
Fax Number	:	321-777-6887

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CLAIRE E. STAGG
Credential	:	DDS
Telephone Number	:	321-777-2797

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	09/25/2017

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