Provider Demographics
NPI:1891585451
Name:LANDRY, DOMINICK
Entity type:Individual
Prefix:
First Name:DOMINICK
Middle Name:
Last Name:LANDRY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 W KELLER ST
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-3418
Mailing Address - Country:US
Mailing Address - Phone:832-792-4006
Mailing Address - Fax:
Practice Address - Street 1:512 W KELLER ST
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-3418
Practice Address - Country:US
Practice Address - Phone:832-792-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)