Provider Demographics
NPI:1326216276
Name:LAHAYE, MARK B (DDS, MS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:B
Last Name:LAHAYE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PECAN ST
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4808
Mailing Address - Country:US
Mailing Address - Phone:985-446-0988
Mailing Address - Fax:985-446-0039
Practice Address - Street 1:100 PECAN ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4808
Practice Address - Country:US
Practice Address - Phone:985-446-0988
Practice Address - Fax:985-446-0039
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA54121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics