Provider Demographics
NPI:1184787921
Name:INDOVINA, ANTHONY A SR (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:INDOVINA
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5132 LAPALCO BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-4238
Mailing Address - Country:US
Mailing Address - Phone:504-340-2401
Mailing Address - Fax:504-340-2423
Practice Address - Street 1:5132 LAPALCO BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4238
Practice Address - Country:US
Practice Address - Phone:504-340-2401
Practice Address - Fax:504-340-2423
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA26501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1826502Medicaid
LA110423OtherCIGNA DMO
LA600034OtherUNITED CONCORDIA
LAA1577OtherBLUE CROSS FEDERAL
LA689358OtherAETNA HMO
LA4013264OtherAETNA EPO
LAA1577OtherBLUE CROSS ID #
LAT19818Medicare UPIN
LA1826502Medicaid