Provider Demographics
NPI:1598897217
Name:G. KIRK SOILEAU, DDS
Entity Type:Organization
Organization Name:G. KIRK SOILEAU, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:SOILEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDD
Authorized Official - Phone:337-363-2514
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-0087
Mailing Address - Country:US
Mailing Address - Phone:337-363-2514
Mailing Address - Fax:337-363-2486
Practice Address - Street 1:113 CALCASIEU ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-4401
Practice Address - Country:US
Practice Address - Phone:337-363-2514
Practice Address - Fax:337-363-2486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1814784Medicaid
LA1834726Medicaid