Provider Demographics
NPI:1568720159
Name:DR. LUKE W. ST. PIERRE (A PROFESSIONAL DENTAL CORPORATION)
Entity Type:Organization
Organization Name:DR. LUKE W. ST. PIERRE (A PROFESSIONAL DENTAL CORPORATION)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE TEAM LEADER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:PAGE
Authorized Official - Last Name:DEROUEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-5375
Mailing Address - Street 1:200 N COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4245
Mailing Address - Country:US
Mailing Address - Phone:337-233-5375
Mailing Address - Fax:337-232-5149
Practice Address - Street 1:200 N COLLEGE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4245
Practice Address - Country:US
Practice Address - Phone:337-233-5375
Practice Address - Fax:337-232-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty