Candice Donielle St. Etienne, DDS
Individual provider Active NPI General Practice Dentistry · Avondale, LA
NPI 1861921355 · NPPES record last updated Jul 3, 2024
Key facts
- NPI
- 1861921355
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 6777 (LA)
- Practice address
- 3932 Highway 90 W
Avondale, LA 70094-2648 - Phone
- (504) 341-4006
- NPI assigned
- Jun 8, 2017
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| I20230315000236 | LA | Order and Referring Only - Dentist |
0749654788 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jacob Dent DDS Dentists of Slidell a Professional Corporation | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8949 | SC | |
| General Practice Dentistry | 1223G0001X | 6777 | LA | Yes |
Addresses
Primary practice location
3932 Highway 90 W
Avondale, LA 70094-2648
Mailing address
3932 Highway 90 W
Avondale, LA 70094-2648
Phone (504) 341-4006
Other providers in Avondale, LA
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- Ernika Smith
- Sabrina Hunter Spears
- Krystal St.Cyr
- Hong Tran
- Trisha Tran
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All providers in Avondale, 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 3, 2024. 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.