Provider Demographics
NPI:1568670685
Name:EDWARD A. LAGA, JR. D.D.S.
Entity Type:Organization
Organization Name:EDWARD A. LAGA, JR. D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAGA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-764-3900
Mailing Address - Street 1:175 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3103
Mailing Address - Country:US
Mailing Address - Phone:207-764-3900
Mailing Address - Fax:207-764-3788
Practice Address - Street 1:175 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3103
Practice Address - Country:US
Practice Address - Phone:207-764-3900
Practice Address - Fax:207-764-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN40021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432544800Medicaid