Provider Demographics
NPI:1922122456
Name:FLOOD, HERBERT R II (DDS)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:R
Last Name:FLOOD
Suffix:II
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 1:52 LAUREL OAK
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5718
Mailing Address - Country:US
Mailing Address - Phone:985-898-4992
Mailing Address - Fax:
Practice Address - Street 1:1744 N CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3110
Practice Address - Country:US
Practice Address - Phone:985-674-5944
Practice Address - Fax:985-674-2957
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA44221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice