Wayne Holden Marionneaux, DDS
Individual provider Active NPI Dentist · Bentone, LA
NPI 1720163587 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1720163587
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 3571 (LA)
- Practice address
- 192 Burt Blvd
Bentone, LA 71006 - Phone
- (318) 965-2424
- Fax
- (318) 965-0943
- NPI assigned
- Oct 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 3571 | LA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Benton Family Dentistry LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3571 | LA | Yes |
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
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.