Provider Demographics
NPI:1992904536
Name:LAGROON, ROBERT JAY (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAY
Last Name:LAGROON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:JAY
Other - Last Name:LAGROON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:791 HWY 7
Mailing Address - Street 2:
Mailing Address - City:MCCORMICK
Mailing Address - State:SC
Mailing Address - Zip Code:29835
Mailing Address - Country:US
Mailing Address - Phone:864-391-9100
Mailing Address - Fax:864-391-9100
Practice Address - Street 1:791 HWY 7
Practice Address - Street 2:
Practice Address - City:MCCORMICK
Practice Address - State:SC
Practice Address - Zip Code:29835
Practice Address - Country:US
Practice Address - Phone:864-391-9100
Practice Address - Fax:864-391-9100
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist