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Organization
NATHAN RAY FONTENOT, JR., APDC
Active
Organization
NATHAN RAY FONTENOT, JR., APDC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NATHAN RAY FONTENOT JR. D.D.S. (OWNER/DENTIST)
(337) 824-4963
Entity
Organization
Contact information
Practice address
715 N MAIN ST, JENNINGS, LA 70546-5311
(337) 824-4963
(337) 824-4961
Mailing address
PO BOX 815, JENNINGS, LA 70546-0815
(337) 824-4963
(337) 824-4961
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3543
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18354319
—
LA
Enumeration date
12/10/2012
Last updated
12/10/2012
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