Provider Demographics
NPI:1629049507
Name:LAGGAN, BRETT THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:THOMAS
Last Name:LAGGAN
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 1:4850 N 9TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2406
Mailing Address - Country:US
Mailing Address - Phone:850-478-7070
Mailing Address - Fax:850-476-2513
Practice Address - Street 1:4850 N 9TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2406
Practice Address - Country:US
Practice Address - Phone:850-748-7070
Practice Address - Fax:850-476-2513
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300210271223S0112X
FLDN189241223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076708500Medicaid