MEDICARE: MR. GORDY LOUIS LANDRY JR. DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2457	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093700130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GORDY LOUIS LANDRY JR. DDS

Provider Business Mailing Address
First Line	:	900 LIVE OAK ST
Second Line	:
City	:	ABBEVILLE
State	:	LA
Zip	:	70510-6558
Country	:	US
Telephone Number	:	337-893-7497
Fax Number	:

Provider Business Practice Location Address
First Line	:	2617 SOUTH DR
Second Line	:
City	:	ABBEVILLE
State	:	LA
Zip	:	70510-4044
Country	:	US
Telephone Number	:	337-893-2614
Fax Number	:	337-893-4662

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/08/2007

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