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General NPI Number Information
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NPI Number | 1225712284
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Entity Type | Organization
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Legal Business Name | JOHN LANDRENEAU
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 07/21/2023
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Provider Practice Location Address
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Address Line | 15615 AIRLINE HWY
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City | PRAIRIEVILLE
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State | LA
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Zip | 70769-4675
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Country | US
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Telephone | 225-677-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 15615 AIRLINE HWY
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City | PRAIRIEVILLE
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State | LA
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Zip | 70769-4675
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | JOHN LANDRENEAU
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Credential |
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Telephone | 225-677-9300
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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 |
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License Number State |
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