MEDICARE: ANN L LAGONEGRO DMD PC

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	0401006522	VA

General Provider Information

NPI Number	:	1295880375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN L LAGONEGRO DMD PC

Provider Business Mailing Address
First Line	:	6093 GEORGE WASHINGTON MEMORIAL HWY
Second Line	:
City	:	GLOUCESTER
State	:	VA
Zip	:	23061-3750
Country	:	US
Telephone Number	:	804-693-9600
Fax Number	:	804-693-7447

Provider Business Practice Location Address
First Line	:	6093 GEORGE WASHINGTON MEMORIAL HWY
Second Line	:
City	:	GLOUCESTER
State	:	VA
Zip	:	23061-3750
Country	:	US
Telephone Number	:	804-693-9600
Fax Number	:	804-693-7447

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANN LUCILLE LAGONEGRO
Credential	:	DMD
Telephone Number	:	804-693-9600

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	06/18/2008

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