Provider Demographics
NPI:1184312142
Name:THERIOT, DILLIAN MATTHEW (DDS)
Entity type:Individual
Prefix:
First Name:DILLIAN
Middle Name:MATTHEW
Last Name:THERIOT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 SAINT ANN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70116-3013
Mailing Address - Country:US
Mailing Address - Phone:337-356-7457
Mailing Address - Fax:
Practice Address - Street 1:5201 VETERANS MEMORIAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5122
Practice Address - Country:US
Practice Address - Phone:504-273-7156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA74521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice