Provider Demographics
NPI:1033258967
Name:DISTEFANO, FRANK J (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:J
Last Name:DISTEFANO
Suffix:
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:PO BOX 2425
Mailing Address - Street 2:907 SECOND ST.
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70381-2425
Mailing Address - Country:US
Mailing Address - Phone:985-384-4751
Mailing Address - Fax:
Practice Address - Street 1:1016 DAVID DR
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1318
Practice Address - Country:US
Practice Address - Phone:985-384-6907
Practice Address - Fax:985-384-6953
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA 2051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist