Provider Demographics
NPI:1386969558
Name:BARGAS, CASEY BRYANT (DDS)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:BRYANT
Last Name:BARGAS
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 1:616 W SALLIER ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5759
Mailing Address - Country:US
Mailing Address - Phone:225-279-0505
Mailing Address - Fax:
Practice Address - Street 1:2640 COUNTRY CLUB RD
Practice Address - Street 2:300
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5912
Practice Address - Country:US
Practice Address - Phone:337-564-6885
Practice Address - Fax:337-564-6907
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA60861223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics