Provider Demographics
NPI:1326197435
Name:FROST, GIGI BRIONES RUSSEL (RDH)
Entity Type:Individual
Prefix:
First Name:GIGI
Middle Name:BRIONES RUSSEL
Last Name:FROST
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5539 MEADOWSWEET CIR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-8821
Mailing Address - Country:US
Mailing Address - Phone:318-456-6620
Mailing Address - Fax:318-456-6636
Practice Address - Street 1:1067 TWINING DR.
Practice Address - Street 2:
Practice Address - City:BARKSDALE AFB
Practice Address - State:LA
Practice Address - Zip Code:71110
Practice Address - Country:US
Practice Address - Phone:318-456-6620
Practice Address - Fax:318-456-6636
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH 18763124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist