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Individual

DR. ENRIQUE LACUESTA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
22-29TH STREET, SUITE A, GULFPORT, MS 39507
(228) 868-9615
(228) 868-9677
Mailing address
22-29TH STREET, SUITE A, GULFPORT, MS 39507
(228) 868-9615
(228) 868-9677

Taxonomy

Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
1758-77
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
755128
UNITED CONCORDIA PROVIDER
MS
Enumeration date
12/19/2006
Last updated
07/08/2007
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