MEDICARE: DR. STANISLAUS JEAN WAGUESPACK D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	5218	LA

General Provider Information

NPI Number	:	1225254618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANISLAUS JEAN WAGUESPACK D.D.S.

Provider Business Mailing Address
First Line	:	4906 AMBASSADOR CAFFERY PKWY BLDG L
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6962
Country	:	US
Telephone Number	:	337-233-3677
Fax Number	:

Provider Business Practice Location Address
First Line	:	4906 AMBASSADOR CAFFERY PKWY BLDG L
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6962
Country	:	US
Telephone Number	:	337-233-3677
Fax Number	:

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	01/24/2024

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