Provider Demographics
NPI:1811554777
Name:STEPHEN M LADUQUE DDS, PA
Entity Type:Organization
Organization Name:STEPHEN M LADUQUE DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-965-2777
Mailing Address - Street 1:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448-1038
Mailing Address - Country:US
Mailing Address - Phone:254-629-3330
Mailing Address - Fax:254-629-3332
Practice Address - Street 1:1420 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-3023
Practice Address - Country:US
Practice Address - Phone:254-629-3330
Practice Address - Fax:254-629-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental