Provider Demographics
NPI:1922484641
Name:JOLIVETTE, MARCELA LILIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCELA
Middle Name:LILIANA
Last Name:JOLIVETTE
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 1:17097 AIRLINE HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3576
Mailing Address - Country:US
Mailing Address - Phone:225-402-4004
Mailing Address - Fax:225-402-4005
Practice Address - Street 1:17097 AIRLINE HWY STE 106
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769
Practice Address - Country:US
Practice Address - Phone:225-402-4004
Practice Address - Fax:225-402-4005
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA66021223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice