Provider Demographics
NPI:1134744782
Name:DUVALL, SYDNEY LAHASKY (DDS)
Entity type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:LAHASKY
Last Name:DUVALL
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 1:4455 RIDGEWAY ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-3961
Mailing Address - Country:US
Mailing Address - Phone:337-967-6235
Mailing Address - Fax:
Practice Address - Street 1:4455 RIDGEWAY ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3961
Practice Address - Country:US
Practice Address - Phone:225-654-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist