Provider Demographics
NPI:1346536190
Name:BERCIER, ANTHONY JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:BERCIER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-0023
Mailing Address - Country:US
Mailing Address - Phone:337-788-0160
Mailing Address - Fax:337-334-2812
Practice Address - Street 1:300 N POLK ST
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-6551
Practice Address - Country:US
Practice Address - Phone:337-334-3581
Practice Address - Fax:337-334-2812
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA61961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice