Healthcare Provider Details

I. General information

NPI: 1396028643
Provider Name (Legal Business Name): DAVID GUIDRY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 10/23/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 CAMELLIA BLVD
LAFAYETTE LA
70508
US

IV. Provider business mailing address

1301 VICTOR II BLVD
MORGAN CITY LA
70380-1453
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-2012
  • Fax: 337-541-0005
Mailing address:
  • Phone: 985-372-2399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6066
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: