Provider Demographics
NPI:1508262528
Name:LAGRAIZE, STACEY (D D S)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:LAGRAIZE
Suffix:
Gender:F
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 MANHATTAN BLVD
Mailing Address - Street 2:SUITE F-201
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-3582
Mailing Address - Country:US
Mailing Address - Phone:504-347-6000
Mailing Address - Fax:
Practice Address - Street 1:1901 MANHATTAN BLVD
Practice Address - Street 2:SUITE F-201
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-3582
Practice Address - Country:US
Practice Address - Phone:504-347-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2015-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist