Healthcare Provider Details

I. General information

NPI: 1669733390
Provider Name (Legal Business Name): HEATHER NICOLE BOYETTE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER NICOLE DELASALLE

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date: 05/29/2025
Reactivation Date: 07/21/2025

III. Provider practice location address

6061 PINNACLE PKWY
COVINGTON LA
70433-9193
US

IV. Provider business mailing address

6061 PINNACLE PKWY
COVINGTON LA
70433-9193
US

V. Phone/Fax

Practice location:
  • Phone: 985-327-6501
  • Fax: 985-327-6506
Mailing address:
  • Phone: 985-327-6501
  • Fax: 985-327-6506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA4741
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7659
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: