Active NPI
Wayne Holden Marionneaux, DDS
- Dentist
- Bentone, LA
National Provider Identifier
1720163587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 3571
- Practice address
- 192 Burt Blvd
Bentone, LA 71006 - Phone
- (318) 965-2424
- Fax
- (318) 965-0943
- NPI assigned
- Oct 27, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3571 | LA | Primary |
Addresses
Primary practice location
192 Burt Blvd
Bentone, LA 71006
Mailing address
PO Box 427
192 Burt Blvd
Benton, LA 71006-0427
Phone (318) 965-2424
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3571 | LA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Benton Family Dentistry LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Benton, LA
- NPI 1821319476
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720163587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 427",
"address_2": "192 BURT BLVD",
"city": "BENTON",
"state": "LA",
"postal_code": "710060427",
"telephone_number": "318-965-2424",
"fax_number": "318-965-0943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "192 BURT BLVD",
"city": "BENTONE",
"state": "LA",
"postal_code": "71006",
"telephone_number": "318-965-2424",
"fax_number": "318-965-0943"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARIONNEAUX",
"first_name": "WAYNE",
"middle_name": "HOLDEN",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "LA",
"license": "3571",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.