MEDICARE: DR. TYLER PAUL LASSEIGNE

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	5574	LA
2	1223P0700X	Prosthodontics	5574	LA

General Provider Information

NPI Number	:	1679776454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYLER PAUL LASSEIGNE

Provider Business Mailing Address
First Line	:	1109 SIMON ST
Second Line	:
City	:	VACHERIE
State	:	LA
Zip	:	70090-5331
Country	:	US
Telephone Number	:	504-416-7440
Fax Number	:

Provider Business Practice Location Address
First Line	:	16645 HIGHLAND RD STE J
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-6567
Country	:	US
Telephone Number	:	225-214-0100
Fax Number	:	225-214-0103

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

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	11/19/2015

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