Provider Demographics
NPI:1588717235
Name:CLAYTON J. CHARBONNET JR,D.D.S.,A.P.O.
Entity type:Organization
Organization Name:CLAYTON J. CHARBONNET JR,D.D.S.,A.P.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHARBONNET
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-340-3838
Mailing Address - Street 1:1905 W THOMAS ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2901
Mailing Address - Country:US
Mailing Address - Phone:985-340-3838
Mailing Address - Fax:
Practice Address - Street 1:1905 W THOMAS ST
Practice Address - Street 2:SUITE M
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2901
Practice Address - Country:US
Practice Address - Phone:985-340-3838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA23491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty