Provider Demographics
NPI:1932414851
Name:MICHAEL D. DAIGLE DDS APC
Entity Type:Organization
Organization Name:MICHAEL D. DAIGLE DDS APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DELANO
Authorized Official - Last Name:DAIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-868-8464
Mailing Address - Street 1:100 MELISSA LN
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4058
Mailing Address - Country:US
Mailing Address - Phone:985-868-8464
Mailing Address - Fax:985-868-0333
Practice Address - Street 1:100 MELISSA LN
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4058
Practice Address - Country:US
Practice Address - Phone:985-868-8464
Practice Address - Fax:985-868-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1825786Medicaid
LA58011Medicare PIN
LA1825786Medicaid