Provider Demographics
NPI:1962414524
Name:JOUANDOT, CHARLES MARION (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MARION
Last Name:JOUANDOT
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 1:3809 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-1625
Mailing Address - Country:US
Mailing Address - Phone:504-833-2211
Mailing Address - Fax:504-828-0802
Practice Address - Street 1:3809 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-1625
Practice Address - Country:US
Practice Address - Phone:504-833-2211
Practice Address - Fax:504-828-0802
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA54831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1854832Medicaid