Provider Demographics
NPI:1649787649
Name:ERIN A. FONTENOT D.D.S., L.L.C.
Entity type:Organization
Organization Name:ERIN A. FONTENOT D.D.S., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:AINSLEY
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-233-8623
Mailing Address - Street 1:100 ANDREW COR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5413
Mailing Address - Country:US
Mailing Address - Phone:337-351-3443
Mailing Address - Fax:
Practice Address - Street 1:1105 S COLLEGE RD STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3067
Practice Address - Country:US
Practice Address - Phone:331-233-8623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty