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General NPI Number Information
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NPI Number | 1386793594
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Entity Type | Organization
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Legal Business Name | LOUISIANA ORTHODONTIC SPECIALISTS
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1301 W TUNNEL BLVD STE. B
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City | HOUMA
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State | LA
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Zip | 70360-2600
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Country | US
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Telephone | 985-853-8510
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Fax | 985-853-8582
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Provider Business Mailing Address
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Address Line | 1301 W TUNNEL BLVD STE. B
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City | HOUMA
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State | LA
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Zip | 70360-2600
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Country | US
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Telephone | 985-853-8510
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Fax | 985-853-8582
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. E E JEANSONNE JR.
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Credential | DDS
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Telephone | 985-853-8510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | OC-11961
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License Number State | LA
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