Provider Demographics
NPI:1356437370
Name:MERMILLIOD, DAVID W (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:MERMILLIOD
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 1:2030 DICKORY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-8519
Mailing Address - Country:US
Mailing Address - Phone:504-737-3525
Mailing Address - Fax:
Practice Address - Street 1:2030 DICKORY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-5816
Practice Address - Country:US
Practice Address - Phone:504-737-3525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA51961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice