Provider Demographics
NPI:1346303237
Name:GAUDET, NOELLE PAIGE
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:PAIGE
Last Name:GAUDET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10522 S GLENSTONE PL
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2875
Mailing Address - Country:US
Mailing Address - Phone:225-769-5377
Mailing Address - Fax:225-769-7910
Practice Address - Street 1:10522 S GLENSTONE PL
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2875
Practice Address - Country:US
Practice Address - Phone:225-769-5377
Practice Address - Fax:225-769-7910
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA55191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1855197Medicaid