Provider Demographics
NPI:1245210269
Name:LAGRECO, ANN LOUISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:LOUISE
Last Name:LAGRECO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANN
Other - Middle Name:LOUISE
Other - Last Name:GILMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1801 FULLER RD STE A-01
Mailing Address - Street 2:NAVAL BRANCH HEALTH CLINIC
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39309-5106
Mailing Address - Country:US
Mailing Address - Phone:601-679-2383
Mailing Address - Fax:
Practice Address - Street 1:NAVAL BRANCH HEALTH CLINIC
Practice Address - Street 2:1801 FULLER RD STE A-01
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39309-5106
Practice Address - Country:US
Practice Address - Phone:601-679-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS63771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice