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General NPI Number Information
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NPI Number | 1497918684
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Entity Type | Individual
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Provider Name | LACY VIRGINIA GARRETT D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 200 HENRY CLAY AVE CHILDREN'S HOSPITAL
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City | NEW ORLEANS
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State | LA
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Zip | 70118-5720
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Country | US
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Telephone | 504-899-9511
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Fax |
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Provider Business Mailing Address
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Address Line | 1676 JEFFERSON AVE
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City | NEW ORLEANS
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State | LA
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Zip | 70115-4949
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Country | US
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Telephone | 478-718-7909
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN013729
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6237
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License Number State | LA
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