Provider Demographics
NPI:1760861298
Name:LOUISIANA DENTAL PROFESSIONALS, DONOVAN DRONET, DDS, A PROFESSIONAL DE
Entity Type:Organization
Organization Name:LOUISIANA DENTAL PROFESSIONALS, DONOVAN DRONET, DDS, A PROFESSIONAL DE
Other - Org Name:CALVERT FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8426
Mailing Address - Street 1:33 CALVERT DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303
Mailing Address - Country:US
Mailing Address - Phone:314-442-6062
Mailing Address - Fax:318-473-0036
Practice Address - Street 1:33 CALVERT DRIVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303
Practice Address - Country:US
Practice Address - Phone:314-442-6062
Practice Address - Fax:318-473-0036
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISIANA DENTAL PROFESSIONALS, DONOVAN DRONET, DDS, A PROFESSIONAL DE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-29
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty