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General NPI Number Information
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NPI Number | 1023177094
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Entity Type | Organization
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Legal Business Name | LEAH THOMPSON GAGNON, D.M.D, P.A.
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 4550 HIGHWAY 20 EAST SUITE C
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City | NICEVILLE
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State | FL
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Zip | 32578
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Country | US
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Telephone | 850-897-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 4550 HIGHWAY 20 EAST SUITE C
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City | NICEVILLE
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State | FL
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Zip | 32578
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Country | US
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Telephone | 850-897-1100
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF DENTAL MEDICINE
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Name | DR. LEAH THOMPSON GAGNON
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Credential | D.M.D.
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Telephone | 850-897-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN 17297
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License Number State | FL
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