Claude M D'Antonio, D.D.S.
Individual provider Active NPI General Practice Dentistry · Bogalusa, LA
NPI 1821186321 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1821186321
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 3135 (LA)
- Practice address
- 218 Memphis St
Bogalusa, LA 70427-3844 - Phone
- (985) 735-0078
- Fax
- (985) 735-0099
- NPI assigned
- Oct 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160119000279 | LA | Order and Referring Only - Other (Physician) |
3577760156 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3135 | LA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bogalusa Dental Associates, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3135 | LA | Yes |
Addresses
Primary practice location
218 Memphis St
Bogalusa, LA 70427-3844
Mailing address
3 Dogwood Dr
Covington, LA 70433-4434
Phone (985) 516-4114
Other providers in Bogalusa, LA
- CPS Drug Store LLC
- Tracey Allen Crain
- Susan Anthony Crawford
- Jennifer Heausler Creech
- Georgia-Lee Beyonce Crumedy
- Derek Gavin Davis
- Jay Davis
- Oleta Davis
- DDMS of Louisiana No 2, LLC
- DDMS of Louisiana No 2, LLC
All providers in Bogalusa, LA · General Practice Dentistry in Louisiana
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.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.