Provider Demographics
NPI:1497391841
Name:THERIOT FAMILY DENTAL CARE-PERKINS LLC
Entity Type:Organization
Organization Name:THERIOT FAMILY DENTAL CARE-PERKINS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THERIOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-258-4939
Mailing Address - Street 1:121 RUE LOUIS XIV STE 2
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5787
Mailing Address - Country:US
Mailing Address - Phone:337-984-3408
Mailing Address - Fax:
Practice Address - Street 1:1930 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-1483
Practice Address - Country:US
Practice Address - Phone:225-344-0391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental