Provider Demographics
NPI:1396751624
Name:BESSONET, CALVIN GREGORY III (DDS)
Entity type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:GREGORY
Last Name:BESSONET
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:13053 HIGHWAY 73
Mailing Address - Street 2:STE A
Mailing Address - City:GEISMAR
Mailing Address - State:LA
Mailing Address - Zip Code:70734-3021
Mailing Address - Country:US
Mailing Address - Phone:504-905-9887
Mailing Address - Fax:225-677-8906
Practice Address - Street 1:13053 HIGHWAY 73
Practice Address - Street 2:STE A
Practice Address - City:GEISMAR
Practice Address - State:LA
Practice Address - Zip Code:70734-3021
Practice Address - Country:US
Practice Address - Phone:225-673-6910
Practice Address - Fax:225-677-8906
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2017-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA5514122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1855146Medicaid