Organization
RAE A. GAUTHIER, DDS, LLC DBA PONCHATOULA FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAE ANN GAUTHIER DDS (OWNER/DENTIST)
(985) 386-8454
Entity
Organization
Contact information
Practice address
430 E PINE ST, PONCHATOULA, LA 70454-2544
(985) 687-3806
(985) 386-8467
Mailing address
430 E PINE ST, PONCHATOULA, LA 70454-2544
(985) 687-3806
(985) 386-8467
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5909
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1859095
—
LA
Enumeration date
09/29/2017
Last updated
07/21/2022
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