Provider Demographics
NPI:1154711802
Name:JACQUELINE R. FAUST, DDS, LLC
Entity type:Organization
Organization Name:JACQUELINE R. FAUST, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAUST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-834-1993
Mailing Address - Street 1:3008 20TH ST STE H
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4900
Mailing Address - Country:US
Mailing Address - Phone:504-834-1993
Mailing Address - Fax:504-834-1620
Practice Address - Street 1:3008 20TH ST STE H
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4900
Practice Address - Country:US
Practice Address - Phone:504-834-1993
Practice Address - Fax:504-834-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA59641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty