Mandeville Dental Associates LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MANDEVILLE DENTAL ASSOCIATES LLC

Practice address

1510 W Causeway Approach Ste B
Mandeville, LA 70471-3022

Phone

(985) 231-7600

NPI assigned

Feb 1, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Timothy Michael Poyadou Jr., DDSNPI 1366785602

Title

Owner

Phone

(985) 266-2000

Specialties & licenses 1

Addresses

Other names 1

• Freeman Smiles Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Timothy Michael Poyadou Jr., B.S., D.D.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Covington, LA
  • NPI 1366785602
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707091200000",
    "number": "1013770189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 TYLER SQ STE 4",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704333060",
            "telephone_number": "985-266-2000",
            "fax_number": "985-266-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 W CAUSEWAY APPROACH STE B",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704713022",
            "telephone_number": "985-231-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANDEVILLE DENTAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-01",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A",
        "authorized_official_last_name": "POYADOU",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-266-2000",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Freeman Smiles",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Freeman Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Regina Mailloux Jensen, LPC, LAC
• Naveed Malik, MD
• Marlee N Maliskas
• Mandeville Cab Co LLC
• Mandeville Chiropractic
• Mandeville Dental Care, LLC
• Mandeville Pharmacy LLC
• Christopher Manguno
• Shelly Ann Mann, LCSW
• Marc Pittman, III, MD, LLC

• Pediatric Dentistry in Mandeville, LA
• Providers in Mandeville, LA by specialty
• Pediatric Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.