NPIMap

Organization Active NPI

Cecil C Gaddis DDS., a Professional Dental Corporation

  • Dentist
  • Jena, LA
National Provider Identifier
1609238336
Registry record updated Mar 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
CECIL C GADDIS DDS., A PROFESSIONAL DENTAL CORPORATION
Practice address
2709 North First Street
Jena, LA 71342
Phone
(318) 992-6175
Fax
(318) 992-6197
NPI assigned
Mar 22, 2016
Last updated
Mar 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2016

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

Authorized official

Name
Dr. Cecil Clyde Gaddis, DDSNPI 1598801367
Title
President
Phone
(318) 992-6175

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X LA Primary

Addresses

Primary practice location

2709 North First Street
Jena, LA 71342

Mailing address

P.O. Box 891
Jena, LA 71342
Phone (318) 992-6175

Other identifiers 1

IdentifierTypeStateIssuer
1826456MedicaidLA

National Provider Directory

National Provider Directory

Locations

2709 N First St
Jena, LA 71342
Phone (318) 992-6175

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458604800000",
    "number": "1609238336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 891",
            "city": "JENA",
            "state": "LA",
            "postal_code": "71342",
            "telephone_number": "318-992-6175",
            "fax_number": "318-992-6197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2709 NORTH FIRST STREET",
            "city": "JENA",
            "state": "LA",
            "postal_code": "71342",
            "telephone_number": "318-992-6175",
            "fax_number": "318-992-6197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CECIL C GADDIS DDS., A PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-22",
        "last_updated": "2016-03-22",
        "status": "A",
        "authorized_official_last_name": "GADDIS",
        "authorized_official_first_name": "CECIL",
        "authorized_official_middle_name": "CLYDE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "318-992-6175",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1826456",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jena, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2016; 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.