Healthcare Provider Details

I. General information

NPI: 1861791204
Provider Name (Legal Business Name): TNONEALYER GENEVA POWERS D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CHISUM ST
SICILY ISLAND LA
71368-4807
US

IV. Provider business mailing address

PO BOX 8
SICILY ISLAND LA
71368-0008
US

V. Phone/Fax

Practice location:
  • Phone: 318-389-9941
  • Fax: 318-389-9943
Mailing address:
  • Phone: 318-389-9941
  • Fax: 318-389-9943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number6139
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: