Provider Demographics
NPI:1679879738
Name:CHUCK C SOILEAU, DDS, LLC
Entity type:Organization
Organization Name:CHUCK C SOILEAU, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:COBY
Authorized Official - Last Name:SOILEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-893-1521
Mailing Address - Street 1:201 S SAINT CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-5901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 S SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-5901
Practice Address - Country:US
Practice Address - Phone:337-893-1521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5983122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1859834Medicaid