Provider Demographics
NPI:1093700130
Name:LANDRY, GORDY LOUIS JR (DDS)
Entity Type:Individual
Prefix:MR
First Name:GORDY
Middle Name:LOUIS
Last Name:LANDRY
Suffix:JR
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 1:900 LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-6558
Mailing Address - Country:US
Mailing Address - Phone:337-893-7497
Mailing Address - Fax:
Practice Address - Street 1:2617 SOUTH DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4044
Practice Address - Country:US
Practice Address - Phone:337-893-2614
Practice Address - Fax:337-893-4662
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA24571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1824577Medicaid