Individual
MS. NANCY JEAN PEMBERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
111 MONSANTO AVE, LULING, LA 70070-2149
(985) 785-0620
(985) 785-0611
Mailing address
111 MONSANTO AVE, LULING, LA 70070-2149
(985) 785-0620
(985) 785-0611
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4504
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184504 3
—
LA
01
—
899161
UNITED CONCORDIA
—
01
—
A2170
BLUE CROSS BLUE SHIELD
—
Enumeration date
07/20/2006
Last updated
07/08/2007
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