Provider Demographics
NPI:1437773215
Name:PERSSON, NATALIE CHILDRESS (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:CHILDRESS
Last Name:PERSSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 POMONA ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-2028
Mailing Address - Country:US
Mailing Address - Phone:985-502-8807
Mailing Address - Fax:
Practice Address - Street 1:27403 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-6401
Practice Address - Country:US
Practice Address - Phone:985-218-9445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70771223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice