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NPI Code Detail

MEDICARE: DR. VAN TERRY HIMEL D.D.S.

MEDICARE: DR. VAN TERRY HIMEL 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
11223E0200XEndodontics2586LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12586OTHERLADENAL LICENSE NUMBER

General Provider Information

NPI Number : 1316030737
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VAN TERRY HIMEL D.D.S.
Provider Business Mailing Address
First Line : 1100 FLORIDA AVE
Second Line : LSUHSC DEPARTMENT OF ENDODONTIC BOX 135
City : NEW ORLEANS
State : LA
Zip : 70119-2714
Country : US
Telephone Number : 504-941-8395
Fax Number :
Provider Business Practice Location Address
First Line : 1100 FLORIDA AVE
Second Line : LSUHSC DEPARTMENT OF ENDODONTICS BOX 135
City : NEW ORLEANS
State : LA
Zip : 70119-2714
Country : US
Telephone Number : 504-941-8395
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2006
Last Update Date : 11/05/2012

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