Provider Demographics
NPI:1659946218
Name:LAGASON, INAH NICOLE LEOSALA
Entity Type:Individual
Prefix:
First Name:INAH NICOLE
Middle Name:LEOSALA
Last Name:LAGASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7941 VERANDAH CT
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8810
Mailing Address - Country:US
Mailing Address - Phone:614-822-1705
Mailing Address - Fax:
Practice Address - Street 1:1601 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1632
Practice Address - Country:US
Practice Address - Phone:740-521-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist