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Organization
LOUISIANA DENTAL GROUP, INC,
Active
Organization
LOUISIANA DENTAL GROUP, INC,
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNIE THERIOT (OFFICE MANAGER)
(337) 258-4939
Entity
Organization
Contact information
Practice address
4702 JOHNSTON ST, SUITE D, LAFAYETTE, LA 70503-4501
(337) 984-3408
(337) 984-9898
Mailing address
4702 JOHNSTON ST, SUITE D, LAFAYETTE, LA 70503-4501
(337) 984-3408
(337) 984-9898
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5429
LA
1223G0001X
General Practice Dentistry
5739
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1334855
—
LA
05
—
1335240
—
LA
05
—
1854298
—
LA
Enumeration date
03/25/2009
Last updated
03/25/2009
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