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General NPI Number Information
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NPI Number | 1659432755
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Entity Type | Organization
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Legal Business Name | ANNETTE D THERIOT DDS & BRYAN P DAIGLE DDS
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1502 MARTENS DR
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City | HAMMOND
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State | LA
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Zip | 70401
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Country | US
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Telephone | 985-345-4242
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Fax | 985-542-5501
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Provider Business Mailing Address
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Address Line | 1502 MARTENS DR
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City | HAMMOND
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State | LA
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Zip | 70401
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Country | US
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Telephone | 985-345-4242
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Fax | 985-542-5501
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ANNETTE D THERIOT
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Credential | DDS
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Telephone | 985-345-4242
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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 | 4545
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License Number State | LA
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