MEDICARE: RODRIGO ADOLFO LAGOS D.D.S., M.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	1223P0300X	Periodontics	49570	CA

General Provider Information

NPI Number	:	1477769081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODRIGO ADOLFO LAGOS D.D.S., M.S.

Provider Business Mailing Address
First Line	:	36945 COOK ST STE 101
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-6077
Country	:	US
Telephone Number	:	760-568-3421
Fax Number	:	760-568-0731

Provider Business Practice Location Address
First Line	:	36945 COOK ST STE 101
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-6077
Country	:	US
Telephone Number	:	760-568-3421
Fax Number	:	760-568-0731

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	09/25/2014

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