Provider Demographics
NPI:1235435314
Name:JOHN TRAHAN II APDC
Entity Type:Organization
Organization Name:JOHN TRAHAN II APDC
Other - Org Name:SMILE DESIGN ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD 'JET'
Authorized Official - Last Name:TRAHAN
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:337-263-4762
Mailing Address - Street 1:PO BOX 12599
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70612-2599
Mailing Address - Country:US
Mailing Address - Phone:337-263-4762
Mailing Address - Fax:
Practice Address - Street 1:139 GLORIA DR.
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611
Practice Address - Country:US
Practice Address - Phone:337-263-4762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA59071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty