Provider Demographics
NPI:1770614430
Name:LACOUR, CHAD A (DDS)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:A
Last Name:LACOUR
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 1:10343 SIEGEN LN STE 1A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-4981
Mailing Address - Country:US
Mailing Address - Phone:225-757-8450
Mailing Address - Fax:
Practice Address - Street 1:10343 SIEGEN LN STE 1A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-4981
Practice Address - Country:US
Practice Address - Phone:225-757-8450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA50371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice