Provider Demographics
NPI:1790991784
Name:PATRICK GUIDRY, D.D.S. A.P.D.C.
Entity Type:Organization
Organization Name:PATRICK GUIDRY, D.D.S. A.P.D.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-687-4892
Mailing Address - Street 1:24021 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-3350
Mailing Address - Country:US
Mailing Address - Phone:225-687-4892
Mailing Address - Fax:225-687-4894
Practice Address - Street 1:24021 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-3350
Practice Address - Country:US
Practice Address - Phone:225-687-4892
Practice Address - Fax:225-687-4894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA39621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty