1033281381 NPI number — JARVIS BYRON FONTENOT DDS

Table of content: JARVIS BYRON FONTENOT DDS (NPI 1033281381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033281381 NPI number — JARVIS BYRON FONTENOT DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FONTENOT
Provider First Name:
JARVIS
Provider Middle Name:
BYRON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1033281381
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1530 E HIGHWAY 30
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GONZALES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70737-4766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-647-9028
Provider Business Mailing Address Fax Number:
225-647-7883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1530 E HIGHWAY 30
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GONZALES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70737-4766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-647-9028
Provider Business Practice Location Address Fax Number:
225-647-7883
Provider Enumeration Date:
11/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , 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)