Provider Demographics
NPI:1033142872
Name:NEUPERT, EDWARD A III (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:NEUPERT
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3839 W. CONGRESS, SUITE C
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506
Mailing Address - Country:US
Mailing Address - Phone:337-981-4566
Mailing Address - Fax:337-981-9006
Practice Address - Street 1:3839 W CONGRESS ST STE C
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6000
Practice Address - Country:US
Practice Address - Phone:337-984-0403
Practice Address - Fax:337-981-9006
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA34451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1834459Medicaid
LAU34680Medicare UPIN
LAU34680Medicare UPIN