Provider Demographics
NPI:1790832442
Name:SOILEAU, GREGORY KIRK (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:KIRK
Last Name:SOILEAU
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:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-0087
Mailing Address - Country:US
Mailing Address - Phone:337-363-2514
Mailing Address - Fax:337-363-2486
Practice Address - Street 1:113 CALCASIEU ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-4401
Practice Address - Country:US
Practice Address - Phone:337-363-2514
Practice Address - Fax:337-363-2486
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA34721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1834726Medicaid
LAG1170OtherBCBS