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NPI Code Detail

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

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
11223G0001XGeneral 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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Directions to “LOUISIANA DENTAL PROFESSIONALS, DONOVAN DRONET, DDS, A PROFESSIONAL DE ” Practice Location

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