Healthcare Provider Details

I. General information

NPI: 1629049507
Provider Name (Legal Business Name): BRETT THOMAS LAGGAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BAPTIST WAY STE 1100
PENSACOLA FL
32503-2254
US

IV. Provider business mailing address

121 BAPTIST WAY STE 1100
PENSACOLA FL
32503-2254
US

V. Phone/Fax

Practice location:
  • Phone: 850-478-7070
  • Fax: 850-476-2513
Mailing address:
  • Phone: 850-478-7070
  • Fax: 850-476-2513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30021027
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN18924
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDN18924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: