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General NPI Number Information
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NPI Number | 1487790929
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Entity Type | Organization
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Legal Business Name | THERIOT FAMILY DENTAL CARE II
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 112 CHURCH ALLEY
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City | NEW IBERIA
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State | LA
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Zip | 70560
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Country | US
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Telephone | 337-369-6587
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Fax | 337-369-3815
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Provider Business Mailing Address
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Address Line | 112 CHURCH ALLEY
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City | NEW IBERIA
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State | LA
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Zip | 70560
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Country | US
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Telephone | 337-369-6587
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Fax | 337-369-3815
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. JOHN CHARLES THERIOT
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Credential | DDS
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Telephone | 337-984-3408
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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 | 5429
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License Number State | LA
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