Provider Demographics
NPI:1720163587
Name:MARIONNEAUX, WAYNE HOLDEN (DDS)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:HOLDEN
Last Name:MARIONNEAUX
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:PO BOX 427
Mailing Address - Street 2:192 BURT BLVD
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-0427
Mailing Address - Country:US
Mailing Address - Phone:318-965-2424
Mailing Address - Fax:318-965-0943
Practice Address - Street 1:192 BURT BLVD
Practice Address - Street 2:
Practice Address - City:BENTONE
Practice Address - State:LA
Practice Address - Zip Code:71006
Practice Address - Country:US
Practice Address - Phone:318-965-2424
Practice Address - Fax:318-965-0943
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3571122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist