Nathan Ray Fontenot, Jr., Apdc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

3543 Issued in LA

Legal business name

NATHAN RAY FONTENOT, JR., APDC

Practice address

715 N Main St
Jennings, LA 70546-5311

Phone

(337) 824-4963

Fax

(337) 824-4961

NPI assigned

Dec 10, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Nathan Ray Fontenot Jr., D.D.S.

Title

Owner/Dentist

Phone

(337) 824-4963

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1355097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355097600000",
    "number": "1114262649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 815",
            "city": "JENNINGS",
            "state": "LA",
            "postal_code": "705460815",
            "telephone_number": "337-824-4963",
            "fax_number": "337-824-4961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 N MAIN ST",
            "city": "JENNINGS",
            "state": "LA",
            "postal_code": "705465311",
            "telephone_number": "337-824-4963",
            "fax_number": "337-824-4961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATHAN RAY FONTENOT, JR., APDC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-10",
        "last_updated": "2012-12-10",
        "status": "A",
        "authorized_official_last_name": "FONTENOT",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "337-824-4963",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "LA",
            "license": "3543",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18354319",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Jennings, LA
• Providers in Jennings, LA by specialty
• Dental Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2012; 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.