Healthcare Provider Details

I. General information

NPI: 1225652449
Provider Name (Legal Business Name): JOSHUA VIRGINIO TAVARES KALUZNY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2238 WORLEY DR
ALEXANDRIA LA
71301-3600
US

IV. Provider business mailing address

2238 WORLEY DR
ALEXANDRIA LA
71301-3600
US

V. Phone/Fax

Practice location:
  • Phone: 318-545-7606
  • Fax: 402-559-9607
Mailing address:
  • Phone: 318-545-7606
  • Fax: 402-559-9607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7665
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7596
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: