Provider Demographics
NPI:1013648245
Name:PUISSEGUR FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:PUISSEGUR FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PUISSEGUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-984-9400
Mailing Address - Street 1:201 RUE LOUIS XIV
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5736
Mailing Address - Country:US
Mailing Address - Phone:337-984-9400
Mailing Address - Fax:
Practice Address - Street 1:201 RUE LOUIS XIV
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5736
Practice Address - Country:US
Practice Address - Phone:337-984-9400
Practice Address - Fax:337-984-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty