Healthcare Provider Details

I. General information

NPI: 1730952078
Provider Name (Legal Business Name): GUIDRY AND HORAIST ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 CAMELLIA BLVD
LAFAYETTE LA
70508
US

IV. Provider business mailing address

1506 CAMELLIA BLVD
LAFAYETTE LA
70508
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DAVID GUIDRY
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 337-232-2012