Provider Demographics
NPI:1598783425
Name:LISTI, DEAN LEONARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:LEONARD
Last Name:LISTI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1316
Mailing Address - Country:US
Mailing Address - Phone:985-384-4044
Mailing Address - Fax:985-384-4043
Practice Address - Street 1:904 DAVID DR
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1316
Practice Address - Country:US
Practice Address - Phone:985-384-4044
Practice Address - Fax:985-384-4043
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA34291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice