MEDICARE: DR. KENNETH E. LAGERGREN 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	1223G0001X	General Practice Dentistry	DE00006042	WA

General Provider Information

NPI Number	:	1427132927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH E. LAGERGREN DDS

Provider Business Mailing Address
First Line	:	1908 GEORGE WASHINGTON WAY # A
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99354-2308
Country	:	US
Telephone Number	:	509-943-5242
Fax Number	:	509-943-5050

Provider Business Practice Location Address
First Line	:	1908 GEORGE WASHINGTON WAY # A
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99354-2308
Country	:	US
Telephone Number	:	509-943-5242
Fax Number	:	509-943-5050

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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