Provider Demographics
NPI:1225156755
Name:LANDRY, DWIGHT DAVID (DDS)
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:DAVID
Last Name:LANDRY
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 1:3909 LAPALCO BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058
Mailing Address - Country:US
Mailing Address - Phone:504-347-6000
Mailing Address - Fax:504-341-3995
Practice Address - Street 1:3909 LAPALCO BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058
Practice Address - Country:US
Practice Address - Phone:504-347-6000
Practice Address - Fax:504-341-3995
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2008-09-30
Deactivation Date:2008-08-19
Deactivation Code:
Reactivation Date:2008-09-30
Provider Licenses
StateLicense IDTaxonomies
LA37081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice