Healthcare Provider Details

I. General information

NPI: 1245731256
Provider Name (Legal Business Name): SETH DEJEAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2018
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 KALISTE SALOOM RD STE B
LAFAYETTE LA
70508-4367
US

IV. Provider business mailing address

110 CRESCENT RIDGE PL
LAFAYETTE LA
70503-4116
US

V. Phone/Fax

Practice location:
  • Phone: 337-722-1510
  • Fax: 337-722-1505
Mailing address:
  • Phone: 225-505-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6906
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: