Provider Demographics
NPI:1578729794
Name:GAUTHIER, RAE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAE
Middle Name:ANN
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3063 GRAND RTE SAINT JOHN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-3026
Mailing Address - Country:US
Mailing Address - Phone:225-721-2048
Mailing Address - Fax:
Practice Address - Street 1:3301 VETERANS BOULEVARD
Practice Address - Street 2:SUITE # 203
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-833-6825
Practice Address - Fax:504-833-5309
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist