Provider Demographics
NPI:1124164330
Name:FOREMAN, EMILY JUDICE (DDS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JUDICE
Last Name:FOREMAN
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 1:300 DOUCET RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3400
Mailing Address - Country:US
Mailing Address - Phone:337-989-1268
Mailing Address - Fax:
Practice Address - Street 1:300 DOUCET RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3400
Practice Address - Country:US
Practice Address - Phone:337-989-1268
Practice Address - Fax:337-989-1268
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA57261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1857262Medicaid