Provider Demographics
NPI:1154545317
Name:MAESTRI, DDS APDC, GINA L
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:L
Last Name:MAESTRI, DDS APDC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 KALISTE SALOOM RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6109
Mailing Address - Country:US
Mailing Address - Phone:337-704-2126
Mailing Address - Fax:337-504-5946
Practice Address - Street 1:1601 KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6109
Practice Address - Country:US
Practice Address - Phone:337-704-2126
Practice Address - Fax:337-504-5946
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
LA5417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies