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Individual

GANTT NICHOLSON DEJEAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS MS

Contact information

Practice address
1604 KERR ST, SUITE 101, OPELOUSAS, LA 70570
(337) 948-8253
(337) 942-8161
Mailing address
1604 KERR ST, SUITE 101, OPELOUSAS, LA 70570
(337) 948-8253
(337) 942-8161

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2435
LA

Other

Enumeration date
02/01/2007
Last updated
07/08/2007
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