Provider Demographics
NPI:1942392303
Name:WAGUESPACK, LAMAR E II (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAMAR
Middle Name:E
Last Name:WAGUESPACK
Suffix:II
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:PO BOX E
Mailing Address - Street 2:
Mailing Address - City:MATHEWS
Mailing Address - State:LA
Mailing Address - Zip Code:70375-0229
Mailing Address - Country:US
Mailing Address - Phone:985-532-5303
Mailing Address - Fax:985-532-5305
Practice Address - Street 1:109 JOHNNY DUFRENE DR
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2611
Practice Address - Country:US
Practice Address - Phone:985-532-5303
Practice Address - Fax:985-532-5305
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA30381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice