Provider Demographics
NPI:1174844450
Name:FONTENOT, ERIN AINSLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:AINSLEY
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 OAK HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8817
Mailing Address - Country:US
Mailing Address - Phone:985-649-9455
Mailing Address - Fax:985-649-9467
Practice Address - Street 1:480 OAK HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8817
Practice Address - Country:US
Practice Address - Phone:985-649-9455
Practice Address - Fax:985-649-9467
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6078122300000X
NC95491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist