Provider Demographics
NPI:1093208936
Name:DOUCET, JONATHAN SAMUEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:SAMUEL
Last Name:DOUCET
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 JULIA ST
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-2618
Mailing Address - Country:US
Mailing Address - Phone:318-728-8773
Mailing Address - Fax:
Practice Address - Street 1:902 JULIA ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-2618
Practice Address - Country:US
Practice Address - Phone:318-728-8773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA68851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice