NPIMap

Organization Active NPI

Louisiana Dental Group, Inc,

  • General Practice Dentistry
  • Lafayette, LA
National Provider Identifier
1942442769
Registry record updated Mar 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5429 Issued in LA
Legal business name
LOUISIANA DENTAL GROUP, INC,
Practice address
4702 Johnston St
Suite D
Lafayette, LA 70503-4501
Phone
(337) 984-3408
Fax
(337) 984-9898
NPI assigned
Mar 25, 2009
Last updated
Mar 25, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeannie Theriot
Title
Office Manager
Phone
(337) 258-4939

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5739 LA
General Practice Dentistry 1223G0001X 5429 LA Primary

Addresses

Primary practice location

4702 Johnston St
Suite D
Lafayette, LA 70503-4501

Mailing address

4702 Johnston St
Suite D
Lafayette, LA 70503-4501
Phone (337) 984-3408

Other identifiers 3

IdentifierTypeStateIssuer
1335240MedicaidLA
1854298MedicaidLA
1334855MedicaidLA

National Provider Directory

National Provider Directory
Tax ID family
Louisiana Dental Group Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

121 Rue Louis Xiv
Ste 2B
Lafayette, LA 70508

4702 Johnston St
Ste D
Lafayette, LA 70503
Phone (337) 984-3408

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237939200000",
    "number": "1942442769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4702 JOHNSTON ST",
            "address_2": "SUITE D",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705034501",
            "telephone_number": "337-984-3408",
            "fax_number": "337-984-9898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4702 JOHNSTON ST",
            "address_2": "SUITE D",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705034501",
            "telephone_number": "337-984-3408",
            "fax_number": "337-984-9898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISIANA DENTAL GROUP, INC,",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-25",
        "last_updated": "2009-03-25",
        "status": "A",
        "authorized_official_last_name": "THERIOT",
        "authorized_official_first_name": "JEANNIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "337-258-4939"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "5739",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "5429",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1335240",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1854298",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1334855",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "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 Mar 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.