MEDICARE: DR. DEAN LEONARD LISTI 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	3429	LA

General Provider Information

NPI Number	:	1598783425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN LEONARD LISTI DDS

Provider Business Mailing Address
First Line	:	904 DAVID DR
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1316
Country	:	US
Telephone Number	:	985-384-4044
Fax Number	:	985-384-4043

Provider Business Practice Location Address
First Line	:	904 DAVID DR
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1316
Country	:	US
Telephone Number	:	985-384-4044
Fax Number	:	985-384-4043

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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