Provider Demographics
NPI:1689992554
Name:BERTHELOT, CLARE MADDOX (DDS)
Entity type:Individual
Prefix:DR
First Name:CLARE
Middle Name:MADDOX
Last Name:BERTHELOT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 PLANK RD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-3501
Mailing Address - Country:US
Mailing Address - Phone:225-330-6622
Mailing Address - Fax:225-356-8163
Practice Address - Street 1:5151 PLANK RD
Practice Address - Street 2:SUITE 28
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-3501
Practice Address - Country:US
Practice Address - Phone:225-330-6622
Practice Address - Fax:225-356-8163
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6031122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist