Provider Demographics
NPI:1245731256
Name:DEJEAN, SETH (DDS)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:DEJEAN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CRESCENT RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-4116
Mailing Address - Country:US
Mailing Address - Phone:225-505-7074
Mailing Address - Fax:
Practice Address - Street 1:854 KALISTE SALOOM RD STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4367
Practice Address - Country:US
Practice Address - Phone:337-722-1510
Practice Address - Fax:337-722-1505
Is Sole Proprietor?:No
Enumeration Date:2018-02-25
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA69061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program