MEDICARE: CASEY BRYANT BARGAS 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	1223E0200X	Endodontics	6086	LA

General Provider Information

NPI Number	:	1386969558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY BRYANT BARGAS D.D.S

Provider Business Mailing Address
First Line	:	616 W SALLIER ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-5759
Country	:	US
Telephone Number	:	225-279-0505
Fax Number	:

Provider Business Practice Location Address
First Line	:	2640 COUNTRY CLUB RD
Second Line	:	300
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5912
Country	:	US
Telephone Number	:	337-564-6885
Fax Number	:	337-564-6907

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

Provider Enumeration Date	:	03/31/2010
Last Update Date	:	12/10/2013

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