Provider Demographics
NPI:1700200045
Name:ST LANDRY DENTAL GROUP,LLC
Entity Type:Organization
Organization Name:ST LANDRY DENTAL GROUP,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHEXNAYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-942-9233
Mailing Address - Street 1:1604 KERR ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-7803
Mailing Address - Country:US
Mailing Address - Phone:337-942-9233
Mailing Address - Fax:337-948-9553
Practice Address - Street 1:1604 KERR ST
Practice Address - Street 2:SUITE 106
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-7803
Practice Address - Country:US
Practice Address - Phone:337-942-9233
Practice Address - Fax:337-948-9553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty