Provider Demographics
NPI:1225355076
Name:SOUTHERN SMILES OF IBERIA, INC
Entity Type:Organization
Organization Name:SOUTHERN SMILES OF IBERIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHAUVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-234-2186
Mailing Address - Street 1:715 N LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2045
Mailing Address - Country:US
Mailing Address - Phone:337-234-2186
Mailing Address - Fax:337-234-1573
Practice Address - Street 1:715 N LEWIS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2045
Practice Address - Country:US
Practice Address - Phone:337-234-2186
Practice Address - Fax:337-234-1573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty