Provider Demographics
NPI:1619005394
Name:CERVINI, DENEAN ANGELLE (DDS, MS)
Entity Type:Individual
Prefix:
First Name:DENEAN
Middle Name:ANGELLE
Last Name:CERVINI
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 W CAUSEWAY APPROACH
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3022
Mailing Address - Country:US
Mailing Address - Phone:985-626-6166
Mailing Address - Fax:985-626-6166
Practice Address - Street 1:1510 W CAUSEWAY APPROACH
Practice Address - Street 2:SUITE B
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3022
Practice Address - Country:US
Practice Address - Phone:985-626-6166
Practice Address - Fax:985-626-6166
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA47741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics