Provider Demographics
NPI:1598829269
Name:VIDRINE, PAUL DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DEAN
Last Name:VIDRINE
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 1:902A SHADY LN
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:LA
Mailing Address - Zip Code:70669
Mailing Address - Country:US
Mailing Address - Phone:337-433-1306
Mailing Address - Fax:337-433-1376
Practice Address - Street 1:902A SHADY LN
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:LA
Practice Address - Zip Code:70669
Practice Address - Country:US
Practice Address - Phone:337-433-1306
Practice Address - Fax:337-433-1376
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA38961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice