Individual
DR. JANETTE T BAGWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
189 KEYSTONE RD, MONROE, LA 71203-8936
(318) 664-5442
(318) 665-4425
Mailing address
189 KEYSTONE RD, MONROE, LA 71203-8936
(318) 664-5442
(318) 665-4425
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4042
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1840424
—
LA
01
—
5545101
AETNA
—
01
—
G7798
BLUE CROSS BLUE SHIELD
LA
Enumeration date
09/20/2006
Last updated
07/08/2007
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