Provider Demographics
NPI:1669033080
Name:DAIGLE, JOHN LESLIE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LESLIE
Last Name:DAIGLE
Suffix:JR
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 1:331 POLK ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-2924
Mailing Address - Country:US
Mailing Address - Phone:985-438-0128
Mailing Address - Fax:
Practice Address - Street 1:3108 W ESPLANADE AVE N
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-1750
Practice Address - Country:US
Practice Address - Phone:504-838-8118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice