Clint Patrick Dutil, D.D.S.
Individual provider Active NPI General Practice Dentistry · Jeanerette, LA
NPI 1124153713 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1124153713
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 5560 (LA)
- Practice address
- 1429 Church St
Jeanerette, LA 70544-4432 - Phone
- (337) 276-4111
- Fax
- (337) 276-4111
- NPI assigned
- Feb 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5560 | LA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5560 | LA | Yes |
Addresses
Primary practice location
1429 Church St
Jeanerette, LA 70544-4432
Mailing address
PO Box 810
Jeanerette, LA 70544-0810
Phone (337) 276-4111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1855600 | Medicaid | LA |
Other providers in Jeanerette, LA
- Cashway Pharmacy of Jeanerette, la. Inc.
- Henrietta Lee Chambers
- City Pharmacy and Home Medical LLC
- Savitra Antoine Collins
- Bradley Dickey
- E&J'S Reliable Medical Transport Services LLC
- Eternal Handhome Care
- Ferguson Abundant Living Medical Transportation LLC
- Deirdre Faye Fontenot
- Terry Allen Frederick
All providers in Jeanerette, LA · General Practice Dentistry in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.