Healthcare Provider Details

I. General information

NPI: 1942762075
Provider Name (Legal Business Name): MICHAEL THOMAS CERTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2019
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FLORIDA AVE
NEW ORLEANS LA
70119-2715
US

IV. Provider business mailing address

2100 SAINT THOMAS ST APT 303
NEW ORLEANS LA
70130-4971
US

V. Phone/Fax

Practice location:
  • Phone: 504-941-8212
  • Fax:
Mailing address:
  • Phone: 516-263-7934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11408
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7736
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: