Active NPI
David Lee Ezernack, D.D.S.
- General Practice Dentistry
- Monroe, LA
National Provider Identifier
1720244668
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2708
- Practice address
- 2109 Redwood Dr
Monroe, LA 71201-3629 - Phone
- (318) 325-7648
- NPI assigned
- Jul 30, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2708 | LA | Primary |
Addresses
Primary practice location
2109 Redwood Dr
Monroe, LA 71201-3629
Mailing address
2109 Redwood Dr
Monroe, LA 71201-3629
Phone (318) 325-7648
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217376000000",
"number": "1720244668",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2109 REDWOOD DR",
"city": "MONROE",
"state": "LA",
"postal_code": "712013629",
"telephone_number": "318-325-7648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2109 REDWOOD DR",
"city": "MONROE",
"state": "LA",
"postal_code": "712013629",
"telephone_number": "318-325-7648"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EZERNACK",
"first_name": "DAVID",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-30",
"last_updated": "2008-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "LA",
"license": "2708",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.