Provider Demographics
NPI:1881852176
Name:FONTENOT, TIMOTHY STEWART (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:STEWART
Last Name:FONTENOT
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 1:149 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-3307
Mailing Address - Country:US
Mailing Address - Phone:337-457-1342
Mailing Address - Fax:337-457-1354
Practice Address - Street 1:149 N 3RD ST
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3307
Practice Address - Country:US
Practice Address - Phone:337-457-1342
Practice Address - Fax:337-457-1354
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice