MEDICARE: LAVOYGER GIES DDS PA

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	122300000X	Dentist	19360	TX

General Provider Information

NPI Number	:	1679721757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAVOYGER GIES DDS PA

Provider Business Mailing Address
First Line	:	9179 GRISSOM RD STE 137
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-2811
Country	:	US
Telephone Number	:	210-522-1777
Fax Number	:

Provider Business Practice Location Address
First Line	:	9179 GRISSOM RD STE 137
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-2811
Country	:	US
Telephone Number	:	210-522-1777
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	LAVOYGER GIES
Credential	:	DDS
Telephone Number	:	210-522-1777

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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