MEDICARE: DR. DARREN WADE CHAUMONT 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	1223G0001X	General Practice Dentistry	5627	LA

General Provider Information

NPI Number	:	1437270139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARREN WADE CHAUMONT DDS

Provider Business Mailing Address
First Line	:	5808 DUNDEE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-7126
Country	:	US
Telephone Number	:	337-477-0545
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 LOUISIANA AVE
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-4634
Country	:	US
Telephone Number	:	337-477-8931
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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