MEDICARE: TOM HEBERT

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	5024	LA

General Provider Information

NPI Number	:	1750593943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOM HEBERT

Provider Business Mailing Address
First Line	:	104 KEMPTON DR
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6547
Country	:	US
Telephone Number	:	225-767-2273
Fax Number	:	225-769-3395

Provider Business Practice Location Address
First Line	:	4451 BLUEBONNET BLVD
Second Line	:	STE A
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-9639
Country	:	US
Telephone Number	:	225-767-2273
Fax Number	:	225-769-3395

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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Directions to “ TOM HEBERT ” Practice Location

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