Individual
DALE M. TRAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, LLC
Contact information
Practice address
102 GENEVIEVE DR, LAFAYETTE, LA 70503-4811
(337) 981-6882
(337) 991-0542
Mailing address
102 GENEVIEVE DR, LAFAYETTE, LA 70503-4811
(337) 981-6882
(337) 991-0542
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3209
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1832090
—
LA
01
—
4065755
BLUECROSSBLUESHIELD OF TN
TN
01
—
427647
UNITED CONCORDIA
LA
01
—
TRZQD354
BLUECROSSBLUESHIELD OF MA
MA
Enumeration date
12/04/2007
Last updated
12/04/2007
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