Provider Demographics
NPI:1932329380
Name:FONSECA, PAULA ISABEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:ISABEL
Last Name:FONSECA
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 1:12565 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6239
Mailing Address - Country:US
Mailing Address - Phone:225-802-6303
Mailing Address - Fax:504-896-1418
Practice Address - Street 1:8000 GSRI AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70820
Practice Address - Country:US
Practice Address - Phone:225-334-1782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAS-4301223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry