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Organization
RAE A. GAUTHIER, DDS, LLC DBA PONCHATOULA FAMILY DENTISTRY
Active
Organization
RAE A. GAUTHIER, DDS, LLC DBA PONCHATOULA FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAE ANN GAUTHIER DDS (OWNER/DENTIST)
(985) 386-8454
Entity
Organization
Contact information
Practice address
430 E PINE ST, PONCHATOULA, LA 70454-2544
(985) 687-3806
(985) 386-8467
Mailing address
430 E PINE ST, PONCHATOULA, LA 70454-2544
(985) 687-3806
(985) 386-8467
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5909
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1859095
—
LA
Enumeration date
09/29/2017
Last updated
07/21/2022
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