Provider Demographics
NPI:1477683779
Name:DOUCET, CHRISTOPHER ELTON (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ELTON
Last Name:DOUCET
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 1:906 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6408
Mailing Address - Country:US
Mailing Address - Phone:337-942-4588
Mailing Address - Fax:337-948-1341
Practice Address - Street 1:906 N UNION ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6408
Practice Address - Country:US
Practice Address - Phone:337-942-4588
Practice Address - Fax:337-948-1341
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA44191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MP1844195Medicaid