MEDICARE: DR. ANGELICA MAHEIA DDS

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	6704	LA

General Provider Information

NPI Number	:	1881046928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELICA MAHEIA DDS

Provider Business Mailing Address
First Line	:	4459 NELSON RD STE 120
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-4136
Country	:	US
Telephone Number	:	337-479-2273
Fax Number	:	337-478-2212

Provider Business Practice Location Address
First Line	:	4459 NELSON RD STE 120
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-4136
Country	:	US
Telephone Number	:	337-479-2273
Fax Number	:	337-478-2212

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

Provider Enumeration Date	:	07/12/2016
Last Update Date	:	07/12/2016

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