Individual
DR. PRESTON G BIVONA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
480 OAK HARBOR BLVD, SLIDELL, LA 70458-8817
(985) 649-9455
Mailing address
436 TIGER AVE, COVINGTON, LA 70433-5261
(504) 919-0199
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7297
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
XHB731919725
—
LA
Enumeration date
06/01/2022
Last updated
06/01/2022
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