Provider Demographics
NPI:1073671137
Name:ANSEL, JUSTIN JOHN SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JOHN
Last Name:ANSEL
Suffix:SR
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 1:4400 TRENTON ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:504-455-3362
Mailing Address - Fax:504-454-3457
Practice Address - Street 1:4400 TRENTON ST
Practice Address - Street 2:SUITE I
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-455-3362
Practice Address - Fax:504-454-3457
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice