Provider Demographics
NPI:1821186321
Name:D'ANTONIO, CLAUDE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:M
Last Name:D'ANTONIO
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 1:3 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4434
Mailing Address - Country:US
Mailing Address - Phone:985-516-4114
Mailing Address - Fax:985-735-0099
Practice Address - Street 1:218 MEMPHIS ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3844
Practice Address - Country:US
Practice Address - Phone:985-735-0078
Practice Address - Fax:985-735-0099
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA31351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice