Healthcare Provider Details

I. General information

NPI: 1053247072
Provider Name (Legal Business Name): THOMAS MICHAEL GASPARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 ONEAL LN STE 1
BATON ROUGE LA
70816-0801
US

IV. Provider business mailing address

39441 QUAIL CREEK AVE
PRAIRIEVILLE LA
70769-4829
US

V. Phone/Fax

Practice location:
  • Phone: 225-753-5303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7835
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: