Provider Demographics
NPI:1922197169
Name:MAHONEY, JOHN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:MAHONEY
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 1:2117 OLD JEANERETTE ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563
Mailing Address - Country:US
Mailing Address - Phone:337-365-5865
Mailing Address - Fax:337-365-6137
Practice Address - Street 1:2117 OLD JEANERETTE RD
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2910
Practice Address - Country:US
Practice Address - Phone:337-365-5865
Practice Address - Fax:337-365-6137
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice