Provider Demographics
NPI:1942375795
Name:RAGUSA, LAUREN A
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:A
Last Name:RAGUSA
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 1:1280 FRONT ST.
Mailing Address - Street 2:
Mailing Address - City:COTTONPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:242 EAST RAILROAD AVE.
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:LA
Practice Address - Zip Code:71358
Practice Address - Country:US
Practice Address - Phone:337-623-3533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA52721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1852724Medicaid