MEDICARE: LOUISIANA DENTAL PROFESSIONALS, DONOVAN DRONET, DDS, A PROFESSIONAL DE

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

General Provider Information

NPI Number	:	1508422007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISIANA DENTAL PROFESSIONALS, DONOVAN DRONET, DDS, A PROFESSIONAL DE

Provider Business Mailing Address
First Line	:	1607 MARTENS DR
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70401-1619
Country	:	US
Telephone Number	:	985-240-5445
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 MARTENS DR
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70401-1619
Country	:	US
Telephone Number	:	985-240-5445
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	BRITTANY HOWARD
Credential	:
Telephone Number	:	217-540-8946

Provider Enumeration Date	:	05/10/2019
Last Update Date	:	05/10/2019

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