Provider Demographics
NPI:1578575247
Name:CHAUVIN, TIMOTHY LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LOUIS
Last Name:CHAUVIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:TIM
Other - Middle Name:LOUIS
Other - Last Name:CHAUVIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:104 ENERGY PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3818
Mailing Address - Country:US
Mailing Address - Phone:337-234-2186
Mailing Address - Fax:337-235-3761
Practice Address - Street 1:104 ENERGY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3818
Practice Address - Country:US
Practice Address - Phone:337-234-2186
Practice Address - Fax:337-235-3761
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1687860OtherUNITED CONCORDIA INS CO'S
LA1853941Medicaid