Healthcare Provider Details

I. General information

NPI: 1235348590
Provider Name (Legal Business Name): RUSSELL CRAIG STRAIT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 S COLLEGE RD
LAFAYETTE LA
70503-3067
US

IV. Provider business mailing address

1105 S COLLEGE RD
LAFAYETTE LA
70503-3067
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-8623
  • Fax: 337-233-8642
Mailing address:
  • Phone: 337-233-8623
  • Fax: 337-233-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: