Provider Demographics
NPI:1558413419
Name:PLUMMER, RODNEY KEITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:KEITH
Last Name:PLUMMER
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 1:1537 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-2333
Mailing Address - Country:US
Mailing Address - Phone:504-945-2099
Mailing Address - Fax:504-945-7262
Practice Address - Street 1:1537 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2333
Practice Address - Country:US
Practice Address - Phone:504-945-2099
Practice Address - Fax:504-945-7262
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA37271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1837270Medicaid
LA12367OtherLA BOARD OF PHARMACY
LA3727OtherSTATE LICENSE
LABP8761454OtherDEA #