Provider Demographics
NPI:1447742143
Name:PRUDHOMME, DAYTON JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAYTON
Middle Name:JAMES
Last Name:PRUDHOMME
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 1:10920 LA HWY 699
Mailing Address - Street 2:
Mailing Address - City:MAURICE
Mailing Address - State:LA
Mailing Address - Zip Code:70555-3601
Mailing Address - Country:US
Mailing Address - Phone:985-687-9022
Mailing Address - Fax:
Practice Address - Street 1:1600 W VETERANS MEML DR
Practice Address - Street 2:
Practice Address - City:KAPLAN
Practice Address - State:LA
Practice Address - Zip Code:70548-3604
Practice Address - Country:US
Practice Address - Phone:337-643-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist