Provider Demographics
NPI:1679776454
Name:LASSEIGNE, TYLER PAUL
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:PAUL
Last Name:LASSEIGNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 SIMON ST
Mailing Address - Street 2:
Mailing Address - City:VACHERIE
Mailing Address - State:LA
Mailing Address - Zip Code:70090-5331
Mailing Address - Country:US
Mailing Address - Phone:504-416-7440
Mailing Address - Fax:
Practice Address - Street 1:16645 HIGHLAND RD STE J
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-6567
Practice Address - Country:US
Practice Address - Phone:225-214-0100
Practice Address - Fax:225-214-0103
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5574122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist