Healthcare Provider Details

I. General information

NPI: 1629407770
Provider Name (Legal Business Name): SHILPA LISTI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 HIGHWAY 167
MAURICE LA
70555
US

IV. Provider business mailing address

4131 HIGHWAY 167
MAURICE LA
70555
US

V. Phone/Fax

Practice location:
  • Phone: 337-263-1110
  • Fax:
Mailing address:
  • Phone: 337-263-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6420
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: