Individual provider Active NPI

Michael Garner Vienne Sr., D.D.S.

  • General Practice Dentistry
  • Natchitoches, LA
National Provider Identifier
1508907908
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4381 Issued in LA
Practice address
129 E 5TH St
Natchitoches, LA 71457-5723
Phone
(318) 352-8751
Fax
(318) 352-9755
NPI assigned
Feb 9, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 4381 LA Primary

Addresses

Primary practice location

129 E 5TH St
Natchitoches, LA 71457-5723

Mailing address

129 E 5TH St
Natchitoches, LA 71457-5723
Phone (318) 352-8751

Other identifiers 1

IdentifierTypeStateIssuer
1843814MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160708000405 LA Order and Referring Only - DentistPractitioner - Dentist 2567754757

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4381LAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508907908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 E 5TH ST",
            "city": "NATCHITOCHES",
            "state": "LA",
            "postal_code": "714575723",
            "telephone_number": "318-352-8751",
            "fax_number": "318-352-9755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 E 5TH ST",
            "city": "NATCHITOCHES",
            "state": "LA",
            "postal_code": "714575723",
            "telephone_number": "318-352-8751",
            "fax_number": "318-352-9755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIENNE",
        "first_name": "MICHAEL",
        "middle_name": "GARNER",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "4381",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1843814",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Natchitoches, LA

Sources for this page

Verify at the official NPI Registry.