Provider Demographics
NPI:1265884373
Name:LAGA, MEGAN (DMD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:LAGA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2156 HARDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-5917
Mailing Address - Country:US
Mailing Address - Phone:863-603-7400
Mailing Address - Fax:
Practice Address - Street 1:2156 HARDEN BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-5917
Practice Address - Country:US
Practice Address - Phone:863-603-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22121122300000X
NC105611223G0001X
FLDN 221211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist