MEDICARE: DR. ANN LOUISE LAGRECO 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	1223G0001X	General Practice Dentistry	6377	KS

General Provider Information

NPI Number	:	1245210269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN LOUISE LAGRECO D.D.S.

Provider Business Mailing Address
First Line	:	1801 FULLER RD STE A-01
Second Line	:	NAVAL BRANCH HEALTH CLINIC
City	:	MERIDIAN
State	:	MS
Zip	:	39309-5106
Country	:	US
Telephone Number	:	601-679-2383
Fax Number	:

Provider Business Practice Location Address
First Line	:	NAVAL BRANCH HEALTH CLINIC
Second Line	:	1801 FULLER RD STE A-01
City	:	MERIDIAN
State	:	MS
Zip	:	39309-5106
Country	:	US
Telephone Number	:	601-679-2383
Fax Number	:

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	07/31/2009

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