Provider Demographics
NPI:1467563221
Name:LAGER, ANDREW TODD (DMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:TODD
Last Name:LAGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 SW ST LUCIE WEST BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1709
Mailing Address - Country:US
Mailing Address - Phone:772-878-7300
Mailing Address - Fax:772-878-9200
Practice Address - Street 1:1420 SW ST LUCIE WEST BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1709
Practice Address - Country:US
Practice Address - Phone:772-878-7300
Practice Address - Fax:772-878-9200
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL143231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice