Provider Demographics
NPI:1285693788
Name:DESSELLE, RENE CHRISTOPHER (DDS)
Entity type:Individual
Prefix:DR
First Name:RENE
Middle Name:CHRISTOPHER
Last Name:DESSELLE
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 1:1837 LEGLISE ST
Mailing Address - Street 2:PO BOX 250
Mailing Address - City:MANSURA
Mailing Address - State:LA
Mailing Address - Zip Code:71350
Mailing Address - Country:US
Mailing Address - Phone:318-964-2300
Mailing Address - Fax:318-964-2302
Practice Address - Street 1:1837 LEGLISE ST
Practice Address - Street 2:
Practice Address - City:MANSURA
Practice Address - State:LA
Practice Address - Zip Code:71350
Practice Address - Country:US
Practice Address - Phone:318-964-2300
Practice Address - Fax:318-964-2302
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1840645Medicaid