Healthcare Provider Details

I. General information

NPI: 1225256332
Provider Name (Legal Business Name): TODAYS DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 HIGHWAY 28 E
PINEVILLE LA
71360-4737
US

IV. Provider business mailing address

5016 HIGHWAY 28 E
PINEVILLE LA
71360-4737
US

V. Phone/Fax

Practice location:
  • Phone: 318-448-4540
  • Fax: 318-484-2837
Mailing address:
  • Phone: 318-448-4540
  • Fax: 318-484-2837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4961
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: JONAS E GAUTHIER
Title or Position: OWNER
Credential: DDS
Phone: 318-448-4540