Healthcare Provider Details

I. General information

NPI: 1043199664
Provider Name (Legal Business Name): ANGELICA LAGASCA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 S ALAMEDA BLVD
LAS CRUCES NM
88005-2818
US

IV. Provider business mailing address

1705 BROWN RD
LAS CRUCES NM
88005-2758
US

V. Phone/Fax

Practice location:
  • Phone: 575-528-6400
  • Fax:
Mailing address:
  • Phone: 904-599-3634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDB-2025-0196
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: