Provider Demographics
NPI:1285788893
Name:DEJONG AND PLAISANCE DENTISTRY PARTNERSHIP
Entity type:Organization
Organization Name:DEJONG AND PLAISANCE DENTISTRY PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT (PARTNER)
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PLAISANCE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-738-5171
Mailing Address - Street 1:10154 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-2446
Mailing Address - Country:US
Mailing Address - Phone:504-738-5171
Mailing Address - Fax:504-738-7923
Practice Address - Street 1:10154 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:RIVER RIDGE
Practice Address - State:LA
Practice Address - Zip Code:70123-2446
Practice Address - Country:US
Practice Address - Phone:504-738-5171
Practice Address - Fax:504-738-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA54981223G0001X
LA33891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty