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General NPI Number Information
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NPI Number | 1932263506
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Entity Type | Organization
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Legal Business Name | PERIODONTICS ASSOCIATES, LLP
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3839 W CONGRESS ST SUITE D
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City | LAFAYETTE
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State | LA
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Zip | 70506-6000
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Country | US
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Telephone | 337-989-0267
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Fax | 337-989-9030
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Provider Business Mailing Address
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Address Line | 3839 W CONGRESS ST SUITE D
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City | LAFAYETTE
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State | LA
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Zip | 70506-6000
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Country | US
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Telephone | 337-989-0267
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Fax | 337-989-9030
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MARK RANDAL COMEAUX
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Credential | DDS
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Telephone | 337-989-0267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 3129
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License Number State | LA
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