MEDICARE: MR. CALVIN GREGORY BESSONET III DDS

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	122300000X	Dentist	5514	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396751624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CALVIN GREGORY BESSONET III DDS

Provider Business Mailing Address
First Line	:	13053 HIGHWAY 73
Second Line	:	STE A
City	:	GEISMAR
State	:	LA
Zip	:	70734-3021
Country	:	US
Telephone Number	:	504-905-9887
Fax Number	:	225-677-8906

Provider Business Practice Location Address
First Line	:	13053 HIGHWAY 73
Second Line	:	STE A
City	:	GEISMAR
State	:	LA
Zip	:	70734-3021
Country	:	US
Telephone Number	:	225-673-6910
Fax Number	:	225-677-8906

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	01/24/2017

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