Provider Demographics
NPI:1750593943
Name:HEBERT, TOM
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:HEBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 KEMPTON DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6547
Mailing Address - Country:US
Mailing Address - Phone:225-767-2273
Mailing Address - Fax:225-769-3395
Practice Address - Street 1:4451 BLUEBONNET BLVD
Practice Address - Street 2:STE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-9639
Practice Address - Country:US
Practice Address - Phone:225-767-2273
Practice Address - Fax:225-769-3395
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA50241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice