Provider Demographics
NPI:1760737431
Name:DECOU, DANIELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:DECOU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:RAE
Other - Last Name:DECOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:217 E KALISTE SALOOM RD
Mailing Address - Street 2:#100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8513
Mailing Address - Country:US
Mailing Address - Phone:337-232-9937
Mailing Address - Fax:337-232-1172
Practice Address - Street 1:217 E KALISTE SALOOM RD
Practice Address - Street 2:#100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8513
Practice Address - Country:US
Practice Address - Phone:337-232-9937
Practice Address - Fax:337-232-1172
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist