Provider Demographics
NPI:1629386032
Name:TRAHAN, JOHN EDWARD 'JET' II (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD 'JET'
Last Name:TRAHAN
Suffix:II
Gender:M
Credentials:DDS, MSD
Other - Prefix:
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Mailing Address - Street 1:139 GLORIA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-5043
Mailing Address - Country:US
Mailing Address - Phone:337-405-0371
Mailing Address - Fax:337-905-8998
Practice Address - Street 1:139 GLORIA DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611-5043
Practice Address - Country:US
Practice Address - Phone:337-405-0371
Practice Address - Fax:337-905-8998
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA59071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics