Organization
NORTHWEST FLORIDA ORAL AND MAXILLOFACIAL SURGERY, PA
Active
Organization
NORTHWEST FLORIDA ORAL AND MAXILLOFACIAL SURGERY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRETT T. LAGGAN D.D.S (ORAL & MAXILLOFACIAL SURGEON)
(850) 478-7070
Entity
Organization
Contact information
Practice address
4850 N 9TH AVE STE 1, SUITE 1, PENSACOLA, FL 32503-2406
(850) 478-7070
(850) 476-2513
Mailing address
4850 N 9TH AVE STE 1, SUITE 1, PENSACOLA, FL 32503-2406
(850) 478-7070
(850) 476-2513
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN18924
FL
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
DN 6078
FL
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
DN18924
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
073210900
—
FL
05
—
076708500
—
FL
Enumeration date
08/24/2010
Last updated
04/12/2011
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