Provider Demographics
NPI:1033415831
Name:LEGGIO, MICHAEL LANCE (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LANCE
Last Name:LEGGIO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-1735
Mailing Address - Country:US
Mailing Address - Phone:504-899-1556
Mailing Address - Fax:504-895-0495
Practice Address - Street 1:4914 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-1735
Practice Address - Country:US
Practice Address - Phone:504-899-1556
Practice Address - Fax:504-895-0495
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist