1386845063 NPI number — JAMES M. FONTENOT DDS AND BARBARA D. FONTENOT DDS (A PROFESSIONAL COR)

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386845063 NPI number — JAMES M. FONTENOT DDS AND BARBARA D. FONTENOT DDS (A PROFESSIONAL COR)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES M. FONTENOT DDS AND BARBARA D. FONTENOT DDS (A PROFESSIONAL COR)
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386845063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
619 CYPRESS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SULPHUR
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70663-5051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-527-3932
Provider Business Mailing Address Fax Number:
337-625-5031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
619 CYPRESS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SULPHUR
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70663-5051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-527-3932
Provider Business Practice Location Address Fax Number:
337-625-5031
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FONTENOT
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
SECRETARY-TREASURER
Authorized Official Telephone Number:
337-527-3932

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2102 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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