Organization
IENNUSA ORTHODONTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ANTHONY IENNUSA JR. DDS (PRESIDENT/ORTHODONTIST)
(985) 626-4779
Entity
Organization
Contact information
Practice address
2245 11TH ST STE C, MANDEVILLE, LA 70471-6498
(985) 626-4779
Mailing address
2245 11TH ST STE C, MANDEVILLE, LA 70471-6498
(985) 626-4779
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5188
LA
Other
Enumeration date
08/16/2013
Last updated
08/16/2013
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