Organization
LAKE AREA DENTISTRY-CARLYSS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFERY HENNIGAN DDS (OWNER)
(337) 478-8470
Entity
Organization
Contact information
Practice address
4985 HIGHWAY 27 S, SULPHUR, LA 70665-7571
(337) 583-2756
Mailing address
4985 HIGHWAY 27 S, SULPHUR, LA 70665-7571
(337) 583-2756
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
LA-6269
LA
Other
Enumeration date
07/11/2018
Last updated
07/11/2018
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