Provider Demographics
NPI:1295731537
Name:DONALD, DENNIS EDWARD I (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:EDWARD
Last Name:DONALD
Suffix:I
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 1:627 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-1521
Mailing Address - Country:US
Mailing Address - Phone:337-478-3646
Mailing Address - Fax:337-478-2853
Practice Address - Street 1:627 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-1521
Practice Address - Country:US
Practice Address - Phone:337-478-3646
Practice Address - Fax:337-478-2853
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA30761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice