Provider Demographics
NPI:1629012984
Name:HARGIS, PAUL CADE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CADE
Last Name:HARGIS
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 1:20970 HIGHWAY 167
Mailing Address - Street 2:
Mailing Address - City:DRY PRONG
Mailing Address - State:LA
Mailing Address - Zip Code:71423-3468
Mailing Address - Country:US
Mailing Address - Phone:318-640-5055
Mailing Address - Fax:318-640-3866
Practice Address - Street 1:20970 HIGHWAY 167
Practice Address - Street 2:
Practice Address - City:DRY PRONG
Practice Address - State:LA
Practice Address - Zip Code:71423-3468
Practice Address - Country:US
Practice Address - Phone:318-640-5055
Practice Address - Fax:318-640-3866
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1848824Medicaid