Healthcare Provider Details

I. General information

NPI: 1053383158
Provider Name (Legal Business Name): JEFFREY W. DONGIEUX, D.D.S. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W ESPLANADE AVE SUITE 101
KENNER LA
70065-3463
US

IV. Provider business mailing address

1900 W ESPLANADE AVE SUITE 101
KENNER LA
70065-3463
US

V. Phone/Fax

Practice location:
  • Phone: 504-468-8300
  • Fax: 504-468-8307
Mailing address:
  • Phone: 504-468-8300
  • Fax: 504-468-8307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5529
License Number StateLA

VIII. Authorized Official

Name: MICHELLE ANN MILLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 504-468-8300