Healthcare Provider Details

I. General information

NPI: 1629012984
Provider Name (Legal Business Name): PAUL CADE HARGIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20970 HIGHWAY 167
DRY PRONG LA
71423-3468
US

IV. Provider business mailing address

20970 HIGHWAY 167
DRY PRONG LA
71423-3468
US

V. Phone/Fax

Practice location:
  • Phone: 318-640-5055
  • Fax: 318-640-3866
Mailing address:
  • Phone: 318-640-5055
  • Fax: 318-640-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4882
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: