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NPI Code Detail

MEDICARE: DR. BRETT THOMAS LAGGAN D.D.S.

MEDICARE: DR. BRETT THOMAS LAGGAN 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
11223S0112XOral and Maxillofacial Surgery (Dentist)30021027OH
21223S0112XOral and Maxillofacial Surgery (Dentist)DN18924FL
3204E00000XOral & Maxillofacial Surgery (D.M.D.)DN18924FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629049507
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRETT THOMAS LAGGAN D.D.S.
Provider Business Mailing Address
First Line : 121 BAPTIST WAY STE 1100
Second Line :
City : PENSACOLA
State : FL
Zip : 32503-2254
Country : US
Telephone Number : 850-478-7070
Fax Number : 850-476-2513
Provider Business Practice Location Address
First Line : 121 BAPTIST WAY STE 1100
Second Line :
City : PENSACOLA
State : FL
Zip : 32503-2254
Country : US
Telephone Number : 850-478-7070
Fax Number : 850-476-2513
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2006
Last Update Date : 10/08/2024

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