Provider Demographics
NPI:1083675946
Name:LORIE A. MOREAU, D.D.S., A.P.D.C.
Entity Type:Organization
Organization Name:LORIE A. MOREAU, D.D.S., A.P.D.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:MOREAU
Authorized Official - Last Name:GODAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-853-0001
Mailing Address - Street 1:1463 SAINT CHARLES ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5014
Mailing Address - Country:US
Mailing Address - Phone:985-853-0001
Mailing Address - Fax:985-853-0024
Practice Address - Street 1:1463 SAINT CHARLES ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5014
Practice Address - Country:US
Practice Address - Phone:985-853-0001
Practice Address - Fax:985-853-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5263261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental