Individual
PETER WALLACE FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
411 E LINCOLN RD, VILLE PLATTE, LA 70586
(337) 363-7290
(337) 363-2339
Mailing address
411 E LINCOLN RD, VILLE PLATTE, LA 70586
(337) 363-7290
(337) 363-2339
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3954
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1839540
—
LA
Enumeration date
08/22/2006
Last updated
07/08/2007
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