Provider Demographics
NPI:1083027890
Name:POYADOU, LETASIA (DMD)
Entity Type:Individual
Prefix:
First Name:LETASIA
Middle Name:
Last Name:POYADOU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5128 OLD HIGHWAY 11
Mailing Address - Street 2:SUITE 11
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-6233
Mailing Address - Country:US
Mailing Address - Phone:601-602-8083
Mailing Address - Fax:
Practice Address - Street 1:5128 OLD HIGHWAY 11
Practice Address - Street 2:SUITE 11
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-6233
Practice Address - Country:US
Practice Address - Phone:601-602-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3749-14122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist