=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174844450
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN AINSLEY FONTENOT D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2010
-----------------------------------------------------
Last Update Date | 10/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 480 OAK HARBOR BLVD
-----------------------------------------------------
City | SLIDELL
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70458-8817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-649-9455
-----------------------------------------------------
Fax | 985-649-9467
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 480 OAK HARBOR BLVD
-----------------------------------------------------
City | SLIDELL
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70458-8817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-649-9455
-----------------------------------------------------
Fax | 985-649-9467
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 6078
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 9549
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------