Provider Demographics
NPI:1558768978
Name:LOUISIANA DENTAL PROFESSIONALS, DONOVAN DRONET, DDS, A PROFESSIONAL DE
Entity Type:Organization
Organization Name:LOUISIANA DENTAL PROFESSIONALS, DONOVAN DRONET, DDS, A PROFESSIONAL DE
Other - Org Name:MAGNOLIA FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8312
Mailing Address - Street 1:204 CRESCENT RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 CRESCENT RANCH BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7530
Practice Address - Country:US
Practice Address - Phone:337-233-1566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISIANA DENTAL PROFESSIONALS, DONOVAN DRONET, DDS, A PROFESSIONAL DE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-01
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty