Provider Demographics
NPI:1306317516
Name:JEANSONNESPILLERSDDSLLC
Entity type:Organization
Organization Name:JEANSONNESPILLERSDDSLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:JEANSONNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-888-7030
Mailing Address - Street 1:1116 S PURPERA AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4361
Mailing Address - Country:US
Mailing Address - Phone:225-647-3577
Mailing Address - Fax:
Practice Address - Street 1:11920 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-0800
Practice Address - Country:US
Practice Address - Phone:225-767-3130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty