Provider Demographics
NPI: | 1932812336 |
---|---|
Name: | JOVIAN S. MONETTE, DDS, A PROFESSIONAL DENTAL CORPORATION |
Entity Type: | Organization |
Organization Name: | JOVIAN S. MONETTE, DDS, A PROFESSIONAL DENTAL CORPORATION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOVIAN |
Authorized Official - Middle Name: | S |
Authorized Official - Last Name: | MONETTE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 504-466-2392 |
Mailing Address - Street 1: | 8847 VETERANS MEMORIAL BLVD STE 8 |
Mailing Address - Street 2: | |
Mailing Address - City: | METAIRIE |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 70003-7707 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 504-466-2392 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8847 VETERANS MEMORIAL BLVD STE 8 |
Practice Address - Street 2: | |
Practice Address - City: | METAIRIE |
Practice Address - State: | LA |
Practice Address - Zip Code: | 70003-7707 |
Practice Address - Country: | US |
Practice Address - Phone: | 504-466-2392 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-12-30 |
Last Update Date: | 2022-12-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |