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General NPI Number Information
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NPI Number | 1215152392
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Entity Type | Organization
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Legal Business Name | DR. DWIGHT D LANDRY A PROFESSIONAL DENTAL CORPORATION - GEISMAR
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | 13353 HIGHWAY 73 SUITE A
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City | GEISMAR
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State | LA
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Zip | 70734-3000
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Country | US
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Telephone | 225-673-0000
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Fax | 225-673-1807
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Provider Business Mailing Address
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Address Line | 13353 HIGHWAY 73 SUITE A
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City | GEISMAR
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State | LA
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Zip | 70734-3000
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Country | US
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Telephone | 225-673-0000
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Fax | 225-673-1807
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Authorized Official
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Title or Position | OWNER
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Name | DR. DWIGHT D LANDRY
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Credential | D.D.S
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Telephone | 225-673-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3708
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License Number State | LA
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