Provider Demographics
NPI:1437904208
Name:STEGALL, LAQUITA DENEEN
Entity type:Individual
Prefix:
First Name:LAQUITA
Middle Name:DENEEN
Last Name:STEGALL
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:PO BOX 750421
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77275-0421
Mailing Address - Country:US
Mailing Address - Phone:281-402-9232
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 750421
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77275-0421
Practice Address - Country:US
Practice Address - Phone:281-402-9232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17335124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist