Ronald Peter Bertucci, D.D.S
Individual provider Active NPI Dentist · Gretna, LA
NPI 1285765545 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1285765545
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 3059 (LA)
- Practice address
- 406 Lafayette St
Gretna, LA 70053-5934 - Phone
- (504) 366-3052
- Fax
- (504) 366-9201
- NPI assigned
- Mar 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 3059 | LA | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3059 | LA | Yes |
Addresses
Primary practice location
406 Lafayette St
Gretna, LA 70053-5934
Mailing address
406 Lafayette St
Gretna, LA 70053-5934
Phone (504) 366-3052
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1830593 | Medicaid | LA |
Other providers in Gretna, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 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.