Provider Demographics
NPI:1730307745
Name:METHVIN, TED (DDS)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:
Last Name:METHVIN
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 1:116 SOUTH DR
Mailing Address - Street 2:STE 102
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5067
Mailing Address - Country:US
Mailing Address - Phone:318-238-3335
Mailing Address - Fax:318-238-3339
Practice Address - Street 1:116 SOUTH DR
Practice Address - Street 2:STE 102
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5067
Practice Address - Country:US
Practice Address - Phone:318-238-3335
Practice Address - Fax:318-238-3339
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193431223G0001X
LA5942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice