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General NPI Number Information
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NPI Number | 1447742143
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Entity Type | Individual
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Provider Name | DAYTON JAMES PRUDHOMME DDS
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Gender | Male
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 1600 W VETERANS MEML DR
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City | KAPLAN
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State | LA
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Zip | 70548-3604
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Country | US
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Telephone | 337-643-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 10920 LA HWY 699
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City | MAURICE
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State | LA
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Zip | 70555-3601
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Country | US
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Telephone | 985-687-9022
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6865
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License Number State | LA
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