Provider Demographics
NPI:1194291146
Name:ACADIA FAMILY DENTISTRY
Entity type:Organization
Organization Name:ACADIA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. AMANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-446-2888
Mailing Address - Street 1:810 BAYOU LN
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:985-447-1007
Practice Address - Street 1:810 BAYOU LN
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4906
Practice Address - Country:US
Practice Address - Phone:985-303-2920
Practice Address - Fax:985-447-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental