Healthcare Provider Details

I. General information

NPI: 1912109323
Provider Name (Legal Business Name): DR. SCOTT J. CEFALU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5213 W NAPOLEON AVE
METAIRIE LA
70001-2266
US

IV. Provider business mailing address

5213 W NAPOLEON AVE
METAIRIE LA
70001-2266
US

V. Phone/Fax

Practice location:
  • Phone: 504-455-2182
  • Fax: 504-455-3536
Mailing address:
  • Phone: 504-455-2182
  • Fax: 504-455-3536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5176
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: