Provider Demographics
NPI:1255367272
Name:FOLSE, GREGORY JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOHN
Last Name:FOLSE
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 1:510 GUILBEAU RD
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-8400
Mailing Address - Country:US
Mailing Address - Phone:337-993-0977
Mailing Address - Fax:337-993-0978
Practice Address - Street 1:510 GUILBEAU RD
Practice Address - Street 2:SUITE C-2
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-8400
Practice Address - Country:US
Practice Address - Phone:337-993-0977
Practice Address - Fax:337-993-0978
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA44231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1844233Medicaid