Provider Demographics
NPI:1851403562
Name:GAUTHIER, KURT E (DDS)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:E
Last Name:GAUTHIER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KURT
Other - Middle Name:E
Other - Last Name:GAUTHIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2235 WORLEY DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301
Mailing Address - Country:US
Mailing Address - Phone:318-442-8915
Mailing Address - Fax:318-442-2493
Practice Address - Street 1:2235 WORLEY DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301
Practice Address - Country:US
Practice Address - Phone:318-442-8915
Practice Address - Fax:318-442-2493
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1851043Medicaid