| Iennusa Orthodontics, Inc. | |
|
2245 11th St Ste C Mandeville LA 70471-6498 | |
| (985) 626-4779 | |
| Not Available |
| Full Name | Iennusa Orthodontics, Inc. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2245 11th St Ste C, Mandeville, Louisiana |
| Authorized Official Name and Position | John Anthony Iennusa (PRESIDENT/ORTHODONTIST) |
| Authorized Official Contact | 9856264779 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Iennusa Orthodontics, Inc. 2245 11th St Ste C Mandeville LA 70471-6498 Ph: (985) 626-4779 | Iennusa Orthodontics, Inc. 2245 11th St Ste C Mandeville LA 70471-6498 Ph: (985) 626-4779 |
| NPI Number | 1306279039 |
|---|---|
| Provider Enumeration Date | 08/16/2013 |
| Last Update Date | 08/16/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306279039 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 5188 (Louisiana) | Primary |
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