Provider Demographics
NPI:1568686657
Name:DUMAS, WILLARD LORING JR (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:LORING
Last Name:DUMAS
Suffix:JR
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:P.O. BOX 4148
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70178-4148
Mailing Address - Country:US
Mailing Address - Phone:504-941-6079
Mailing Address - Fax:
Practice Address - Street 1:4201 N RAMPART ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-5334
Practice Address - Country:US
Practice Address - Phone:504-941-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA23171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1823171Medicaid