Provider Demographics
NPI:1134220361
Name:FAVALORO, FRANK BOYD (D D S)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:BOYD
Last Name:FAVALORO
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX G
Mailing Address - Street 2:
Mailing Address - City:LUTCHER
Mailing Address - State:LA
Mailing Address - Zip Code:70071-0836
Mailing Address - Country:US
Mailing Address - Phone:225-869-8281
Mailing Address - Fax:225-869-8868
Practice Address - Street 1:2024 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071-0836
Practice Address - Country:US
Practice Address - Phone:225-869-8281
Practice Address - Fax:225-869-8868
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA22811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice