Provider Demographics
NPI:1508918343
Name:CLAYTON J. CHARBONNET JR., D.D.S., A.P.O
Entity Type:Organization
Organization Name:CLAYTON J. CHARBONNET JR., D.D.S., A.P.O
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARBONNET
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:9853-403-3838
Mailing Address - Street 1:5036 YALE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-3980
Mailing Address - Country:US
Mailing Address - Phone:504-456-7874
Mailing Address - Fax:
Practice Address - Street 1:5036 YALE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3980
Practice Address - Country:US
Practice Address - Phone:504-456-7874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA23491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty