Individual
DR. JOHN IENNUSA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2245 11TH ST STE C, MANDEVILLE, LA 70471-6498
(985) 626-4779
Mailing address
2245 11TH ST STE C, MANDEVILLE, LA 70471-6498
(985) 626-4779
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
5188
LA
Other
Enumeration date
07/17/2013
Last updated
07/17/2013
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