Provider Demographics
NPI:1053383158
Name:JEFFREY W. DONGIEUX, D.D.S. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JEFFREY W. DONGIEUX, D.D.S. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-468-8300
Mailing Address - Street 1:1900 W ESPLANADE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3463
Mailing Address - Country:US
Mailing Address - Phone:504-468-8300
Mailing Address - Fax:504-468-8307
Practice Address - Street 1:1900 W ESPLANADE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3463
Practice Address - Country:US
Practice Address - Phone:504-468-8300
Practice Address - Fax:504-468-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA55291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1855294Medicaid