Healthcare Provider Details

I. General information

NPI: 1740374636
Provider Name (Legal Business Name): GINGER BATTLE STAGG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 ABNER JACKSON PKWY
LAKE JACKSON TX
77566-5163
US

IV. Provider business mailing address

3606 DOGWOOD BLOSSOM CT
PEARLAND TX
77581
US

V. Phone/Fax

Practice location:
  • Phone: 979-297-5437
  • Fax: 979-299-6166
Mailing address:
  • Phone: 281-412-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number21439
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: