Cecil Clyde Gaddis, DDS
Individual provider Active NPI Dentist · Jena, LA
NPI 1598801367 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1598801367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2645 (LA)
- Practice address
- 2709 North First Street
Jena, LA 71342 - Phone
- (318) 992-6175
- Fax
- (318) 992-6197
- NPI assigned
- Jan 29, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Nov 5, 2015 through Nov 5, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2645 | LA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cecil C Gaddis DDS., a Professional Dental Corporation | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2645 | LA | Yes |
Addresses
Primary practice location
2709 North First Street
Jena, LA 71342
Mailing address
PO Box 891
Jena, LA 71342
Phone (318) 992-6175
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1826456 | Medicaid | LA |
Other names
- Dr. C C Gaddis
Other providers in Jena, 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.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.