Individual
DR. FRED A LACOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2505 N MAYFAIR RD, #103, WAUWATOSA, WI 53226
(414) 258-2117
(414) 258-4177
Mailing address
2505 N MAYFAIR RD, #103, WAUWATOSA, WI 53226
(414) 258-2117
(414) 258-4177
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3547WI
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
690859
UNITED HEALTHCARE
—
Enumeration date
11/07/2006
Last updated
07/08/2007
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