MEDICARE: DR. ROBERT SERGENT D.M.D.

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	15065	FL
2	122300000X	Dentist	P-91	LA

General Provider Information

NPI Number	:	1588625842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT SERGENT D.M.D.

Provider Business Mailing Address
First Line	:	1100 FLORIDA AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-2714
Country	:	US
Telephone Number	:	504-256-0021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 FLORIDA AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-2714
Country	:	US
Telephone Number	:	504-256-0021
Fax Number	:

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	05/08/2009

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