Provider Demographics
NPI:1114461191
Name:BRIGNAC, WESLEY JR (DDS)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:BRIGNAC
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 1:7205 HIGHWAY 74
Mailing Address - Street 2:
Mailing Address - City:SAINT GABRIEL
Mailing Address - State:LA
Mailing Address - Zip Code:70776-4827
Mailing Address - Country:US
Mailing Address - Phone:225-319-2385
Mailing Address - Fax:
Practice Address - Street 1:7205 HIGHWAY 74
Practice Address - Street 2:
Practice Address - City:SAINT GABRIEL
Practice Address - State:LA
Practice Address - Zip Code:70776-4827
Practice Address - Country:US
Practice Address - Phone:225-319-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist