MEDICARE: PATRICK MICHAEL LONERGAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4200	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A2103	OTHER	LA	BCBS

General Provider Information

NPI Number	:	1033281076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK MICHAEL LONERGAN DDS

Provider Business Mailing Address
First Line	:	3330 KINGMAN STREET
Second Line	:	SUITE 5
City	:	METAIRIE
State	:	LA
Zip	:	70006
Country	:	US
Telephone Number	:	504-887-1700
Fax Number	:	504-887-6179

Provider Business Practice Location Address
First Line	:	3621 RIDGELAKE DR STE 203
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70002-1739
Country	:	US
Telephone Number	:	504-887-1700
Fax Number	:	504-887-6179

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	12/11/2019

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