Provider Demographics
NPI:1457382889
Name:LANDRENEAU, JOHN PIERRE (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PIERRE
Last Name:LANDRENEAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:LANDRENEAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 1734
Mailing Address - Street 2:15615 AIRLINE HWY. SUITE C
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-1734
Mailing Address - Country:US
Mailing Address - Phone:225-677-9300
Mailing Address - Fax:225-677-9384
Practice Address - Street 1:15615 AIRLINE HWY. SUITEC
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-1734
Practice Address - Country:US
Practice Address - Phone:225-677-9300
Practice Address - Fax:225-677-9384
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3706122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist