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General NPI Number Information
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NPI Number | 1659946218
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Entity Type | Individual
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Provider Name | INAH NICOLE LEOSALA LAGASON
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Gender | Female
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 1601 N MEMORIAL DR
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City | LANCASTER
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State | OH
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Zip | 43130-1632
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Country | US
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Telephone | 740-521-4142
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Fax |
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Provider Business Mailing Address
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Address Line | 7941 VERANDAH CT
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City | POWELL
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State | OH
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Zip | 43065-8810
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Country | US
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Telephone | 614-822-1705
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.026517
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License Number State | OH
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