Provider Demographics
NPI:1356147268
Name:PEDIATRIC DENTAL SPECIALISTS OF LAFAYETTE
Entity type:Organization
Organization Name:PEDIATRIC DENTAL SPECIALISTS OF LAFAYETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DEJEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-722-1510
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty