Provider Demographics
NPI:1699803650
Name:DIGNEY, TARO MIWA (DDS)
Entity type:Individual
Prefix:DR
First Name:TARO
Middle Name:MIWA
Last Name:DIGNEY
Suffix:
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 1:833 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-4227
Mailing Address - Country:US
Mailing Address - Phone:504-400-2672
Mailing Address - Fax:318-742-2288
Practice Address - Street 1:2281 BENTON RD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3403
Practice Address - Country:US
Practice Address - Phone:318-742-9852
Practice Address - Fax:318-742-2288
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA57641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice