Provider Demographics
NPI:1336240498
Name:CAUSIN, CHANTAL LYNN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:CHANTAL
Middle Name:LYNN
Last Name:CAUSIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2083 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-6426
Mailing Address - Country:US
Mailing Address - Phone:985-624-8602
Mailing Address - Fax:985-624-8881
Practice Address - Street 1:2083 3RD ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-6426
Practice Address - Country:US
Practice Address - Phone:985-624-8602
Practice Address - Fax:985-624-8881
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA52341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice