Individual
CLINT PATRICK DUTIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1429 CHURCH ST, JEANERETTE, LA 70544-4432
(337) 276-4111
(337) 276-4111
Mailing address
PO BOX 810, JEANERETTE, LA 70544-0810
(337) 276-4111
(337) 276-4111
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5560
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1855600
—
LA
Enumeration date
02/22/2007
Last updated
07/09/2007
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