| Lake Area Dentistry-dequincy, Llc | |
|
824 W 4th St Dequincy LA 70633 | |
| (337) 786-6221 | |
| Not Available |
| Full Name | Lake Area Dentistry-dequincy, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 824 W 4th St, Dequincy, Louisiana |
| Authorized Official Name and Position | Jeffery Allen Hennigan (OWNER/DENTIST) |
| Authorized Official Contact | 3377866221 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Area Dentistry-dequincy, Llc 824 W 4th St Dequincy LA 70633 Ph: (337) 786-6221 | Lake Area Dentistry-dequincy, Llc 824 W 4th St Dequincy LA 70633 Ph: (337) 786-6221 |
| NPI Number | 1598209207 |
|---|---|
| Provider Enumeration Date | 12/14/2016 |
| Last Update Date | 12/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598209207 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | LA-6269 (Louisiana) | Primary |