Provider Demographics
NPI:1508045212
Name:GAUDET, ELMER LAWRENCE JR (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:ELMER
Middle Name:LAWRENCE
Last Name:GAUDET
Suffix:JR
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2599 RUE PALAFOX
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-3734
Mailing Address - Country:US
Mailing Address - Phone:228-594-3435
Mailing Address - Fax:
Practice Address - Street 1:2599 RUE PALAFOX
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-3734
Practice Address - Country:US
Practice Address - Phone:228-594-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1067-621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics