| Louisiana Dental Group, Inc, | |
|
4702 Johnston St Suite D Lafayette LA 70503-4501 | |
| (337) 984-3408 | |
| (337) 984-9898 |
| Full Name | Louisiana Dental Group, Inc, |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4702 Johnston St, Lafayette, Louisiana |
| Authorized Official Name and Position | Jeannie Theriot (OFFICE MANAGER) |
| Authorized Official Contact | 3372584939 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Louisiana Dental Group, Inc, 4702 Johnston St Suite D Lafayette LA 70503-4501 Ph: (337) 984-3408 | Louisiana Dental Group, Inc, 4702 Johnston St Suite D Lafayette LA 70503-4501 Ph: (337) 984-3408 |
| NPI Number | 1942442769 |
|---|---|
| Provider Enumeration Date | 03/25/2009 |
| Last Update Date | 03/25/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942442769 | NPI | - | NPPES |
| 1854298 | Medicaid | LA | |
| 1334855 | Medicaid | LA | |
| 1335240 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5429 (Louisiana) | Primary |
| 1223G0001X | Dentist - General Practice | 5739 (Louisiana) | Secondary |
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