1225156755 NPI number — MR. DWIGHT DAVID LANDRY DDS

Table of content: MR. DWIGHT DAVID LANDRY DDS (NPI 1225156755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225156755 NPI number — MR. DWIGHT DAVID LANDRY DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANDRY
Provider First Name:
DWIGHT
Provider Middle Name:
DAVID
Provider Name Prefix Text:
MR.
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:
1225156755
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/19/2008
NPI Reactivation Date:
09/30/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3909 LAPALCO BLVD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
HARVEY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-347-6000
Provider Business Mailing Address Fax Number:
504-341-3995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3909 LAPALCO BLVD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
HARVEY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-347-6000
Provider Business Practice Location Address Fax Number:
504-341-3995
Provider Enumeration Date:
03/26/2007

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 , with the licence number:  3708 , 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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