Provider Demographics
NPI:1558646000
Name:GIROD, JOSHUA KEITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:KEITH
Last Name:GIROD
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 1:17398 E AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-5760
Mailing Address - Country:US
Mailing Address - Phone:225-938-9639
Mailing Address - Fax:
Practice Address - Street 1:318 E CORNERVIEW ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-3152
Practice Address - Country:US
Practice Address - Phone:225-644-2183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist