Provider Demographics
NPI:1851146112
Name:VICTOR J CARONNA DDS LLC
Entity Type:Organization
Organization Name:VICTOR J CARONNA DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CARONNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-443-5013
Mailing Address - Street 1:213 ANSLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3782
Mailing Address - Country:US
Mailing Address - Phone:318-443-5013
Mailing Address - Fax:
Practice Address - Street 1:213 ANSLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3782
Practice Address - Country:US
Practice Address - Phone:318-443-5013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty