MEDICARE: SULPHUR DENTAL ASSOCIATES

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	LA3929	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	:	1114317666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SULPHUR DENTAL ASSOCIATES

Provider Business Mailing Address
First Line	:	2920 MAPLEWOOD DR
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70663-6114
Country	:	US
Telephone Number	:	337-625-2671
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 MAPLEWOOD DR
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70663-6114
Country	:	US
Telephone Number	:	337-625-2671
Fax Number	:

Authorized Official
Title or Position	:	DENTIST / OWNER
Name	:	DR. GARY JOSEPH BLANCHETTE
Credential	:
Telephone Number	:	337-625-2671

Provider Enumeration Date	:	02/04/2015
Last Update Date	:	02/04/2015

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Directions to “SULPHUR DENTAL ASSOCIATES ” Practice Location

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