Provider Demographics
NPI:1386793594
Name:LOUISIANA ORTHODONTIC SPECIALISTS
Entity type:Organization
Organization Name:LOUISIANA ORTHODONTIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:E
Authorized Official - Middle Name:E
Authorized Official - Last Name:JEANSONNE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-853-8510
Mailing Address - Street 1:1301 W TUNNEL BLVD
Mailing Address - Street 2:STE. B
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2600
Mailing Address - Country:US
Mailing Address - Phone:985-853-8510
Mailing Address - Fax:985-853-8582
Practice Address - Street 1:1301 W TUNNEL BLVD
Practice Address - Street 2:STE. B
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2600
Practice Address - Country:US
Practice Address - Phone:985-853-8510
Practice Address - Fax:985-853-8582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOC-119611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty