Provider Demographics
NPI:1851507776
Name:LORRAINE, RHONDA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:ANN
Last Name:LORRAINE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14666 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUT OFF
Mailing Address - State:LA
Mailing Address - Zip Code:70345-3205
Mailing Address - Country:US
Mailing Address - Phone:985-632-6188
Mailing Address - Fax:985-632-4448
Practice Address - Street 1:14666 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CUT OFF
Practice Address - State:LA
Practice Address - Zip Code:70345-3205
Practice Address - Country:US
Practice Address - Phone:985-632-6188
Practice Address - Fax:985-632-4448
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA51191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice