Provider Demographics
NPI:1033281076
Name:LONERGAN, PATRICK MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:MICHAEL
Last Name:LONERGAN
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 1:3330 KINGMAN STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:504-887-1700
Mailing Address - Fax:504-887-6179
Practice Address - Street 1:3621 RIDGELAKE DR STE 203
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-1739
Practice Address - Country:US
Practice Address - Phone:504-887-1700
Practice Address - Fax:504-887-6179
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAA2103OtherBCBS