Provider Demographics
NPI:1174192165
Name:MAINIERI, THOMAS DEMIE FEJES (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DEMIE FEJES
Last Name:MAINIERI
Suffix:
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 1:11258 HILLPARK AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7790
Mailing Address - Country:US
Mailing Address - Phone:225-326-0828
Mailing Address - Fax:
Practice Address - Street 1:5188 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-6527
Practice Address - Country:US
Practice Address - Phone:225-766-8107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA72011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice