Provider Demographics
NPI:1437281912
Name:CEFALU, THOMAS VINCENT JR
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:VINCENT
Last Name:CEFALU
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 W NAPOLEON AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-2266
Mailing Address - Country:US
Mailing Address - Phone:504-455-2182
Mailing Address - Fax:
Practice Address - Street 1:5213 W NAPOLEON AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2266
Practice Address - Country:US
Practice Address - Phone:504-455-2182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice