Organization
LEAH THOMPSON GAGNON, D.M.D, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEAH THOMPSON GAGNON D.M.D. (DOCTOR OF DENTAL MEDICINE)
(850) 897-1100
Entity
Organization
Contact information
Practice address
4550 HIGHWAY 20 EAST, SUITE C, NICEVILLE, FL 32578
(850) 897-1100
Mailing address
4550 HIGHWAY 20 EAST, SUITE C, NICEVILLE, FL 32578
(850) 897-1100
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN 17297
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235273392
NPI TYPE 1
FL
Enumeration date
12/06/2006
Last updated
01/25/2010
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