MEDICARE: DR. MICHAEL J PUISSEGUR D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		LA

General Provider Information

NPI Number	:	1154496628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J PUISSEGUR D.D.S.

Provider Business Mailing Address
First Line	:	201 RUE LOUIS XIV
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508
Country	:	US
Telephone Number	:	337-984-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 RUE LOUIS XIV
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-5736
Country	:	US
Telephone Number	:	337-984-9400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	06/20/2022

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