Active NPI
Carl J Breaux, D.D.S.
- General Practice Dentistry
- Lafayette, LA
National Provider Identifier
1801012018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3761
- Practice address
- 300 Bertrand Dr
Lafayette, LA 70506-5635 - Phone
- (337) 261-0214
- Fax
- (337) 235-3550
- NPI assigned
- Apr 17, 2007
- 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 | 3761 | LA | Primary |
Addresses
Primary practice location
300 Bertrand Dr
Lafayette, LA 70506-5635
Mailing address
300 Bertrand Dr
Lafayette, LA 70506-5635
Phone (337) 261-0214
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1837610 | Medicaid | LA | |
| 1801012018 | Other | LA | DEPARTMENT OF VETERANS AFFAIRS |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Lafayette | Direct |
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 |
|---|---|---|---|
| 3761 | LA | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582761600000",
"number": "1801012018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 BERTRAND DR",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705065635",
"telephone_number": "337-261-0214",
"fax_number": "337-235-3550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 BERTRAND DR",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705065635",
"telephone_number": "337-261-0214",
"fax_number": "337-235-3550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREAUX",
"first_name": "CARL",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-17",
"last_updated": "2020-02-27",
"certification_date": "2020-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "LA",
"license": "3761",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1837610",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPARTMENT OF VETERANS AFFAIRS",
"identifier": "1801012018",
"state": "LA"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Lafayette",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "300 Bertrand Dr",
"city": "Lafayette",
"state": "LA",
"country_code": "US",
"postal_code": "705065635",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lafayette, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.