Provider Demographics
NPI:1639227721
Name:D'AQUIN, DONALD JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JOSEPH
Last Name:D'AQUIN
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 1:720 VERRET ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4634
Mailing Address - Country:US
Mailing Address - Phone:985-868-7470
Mailing Address - Fax:985-868-4640
Practice Address - Street 1:720 VERRET ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4634
Practice Address - Country:US
Practice Address - Phone:985-868-7470
Practice Address - Fax:985-868-4640
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA31361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA183136Medicaid