Provider Demographics
NPI:1780685453
Name:DALE, DENNIS MAESTRI (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:MAESTRI
Last Name:DALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:985-643-9704
Mailing Address - Fax:985-643-2813
Practice Address - Street 1:1850 GAUSE BLVD E
Practice Address - Street 2:SUITE 202
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5442
Practice Address - Country:US
Practice Address - Phone:985-639-3777
Practice Address - Fax:985-661-3517
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017248207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06354594Medicaid
LA1957267Medicaid
LA54712Medicare PIN
MS06354594Medicaid
LA331643YH3UMedicare PIN