Provider Demographics
NPI:1700804473
Name:MAUDUIT, KENT RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:RAYMOND
Last Name:MAUDUIT
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 1:117 BELLE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-5905
Mailing Address - Country:US
Mailing Address - Phone:985-652-4379
Mailing Address - Fax:
Practice Address - Street 1:429 W AIRLINE HWY STE F
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3817
Practice Address - Country:US
Practice Address - Phone:985-652-3121
Practice Address - Fax:985-651-0701
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA37191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice