Provider Demographics
NPI:1851543920
Name:TURGEON, JONATHAN B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:B
Last Name:TURGEON
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 1:2160 AIRLINE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-1608
Mailing Address - Country:US
Mailing Address - Phone:318-741-6778
Mailing Address - Fax:318-741-6780
Practice Address - Street 1:2160 AIRLINE DR
Practice Address - Street 2:SUITE B
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-1608
Practice Address - Country:US
Practice Address - Phone:318-741-6778
Practice Address - Fax:318-741-6780
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA59371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$BOtherBLUE CROSS BLUE SHIELD OF LA