Provider Demographics
NPI:1588825319
Name:MOREAU, LORIE ANN (DDS)
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:ANN
Last Name:MOREAU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LORIE
Other - Middle Name:ANN
Other - Last Name:MOREAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:905 SAN ANTONIO BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-6200
Mailing Address - Country:US
Mailing Address - Phone:985-856-4270
Mailing Address - Fax:
Practice Address - Street 1:600 VALHI BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5976
Practice Address - Country:US
Practice Address - Phone:985-872-3677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA52631223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice