Provider Demographics
NPI:1235206541
Name:DAIRE, JOHN CREIGHTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CREIGHTER
Last Name:DAIRE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:858 KALISTE SALOOM RD
Mailing Address - Street 2:A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-291-9141
Mailing Address - Fax:337-291-9493
Practice Address - Street 1:858 KALISTE SALOOM RD
Practice Address - Street 2:A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-291-9141
Practice Address - Fax:337-291-9493
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA32691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1832693Medicaid
LA1832693Medicaid