Healthcare Provider Details

I. General information

NPI: 1932414851
Provider Name (Legal Business Name): MICHAEL D. DAIGLE DDS APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MELISSA LN
HOUMA LA
70360-4058
US

IV. Provider business mailing address

100 MELISSA LN
HOUMA LA
70360-4058
US

V. Phone/Fax

Practice location:
  • Phone: 985-868-8464
  • Fax: 985-868-0333
Mailing address:
  • Phone: 985-868-8464
  • Fax: 985-868-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL DELANO DAIGLE
Title or Position: OWNER
Credential: DDS
Phone: 985-868-8464