Provider Demographics
NPI:1407983711
Name:VIDRINE, JEAN PHILIPPE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:PHILIPPE
Last Name:VIDRINE
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 1:717 W LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-3147
Mailing Address - Country:US
Mailing Address - Phone:337-363-2030
Mailing Address - Fax:337-363-3611
Practice Address - Street 1:717 W LINCOLN RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-3147
Practice Address - Country:US
Practice Address - Phone:337-363-2030
Practice Address - Fax:337-363-3611
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA43201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1843202Medicaid