| Nathan Ray Fontenot, Jr., Apdc | |
|
715 N Main St Jennings LA 70546-5311 | |
| (337) 824-4963 | |
| (337) 824-4961 |
| Full Name | Nathan Ray Fontenot, Jr., Apdc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 715 N Main St, Jennings, Louisiana |
| Authorized Official Name and Position | Nathan Ray Fontenot (OWNER/DENTIST) |
| Authorized Official Contact | 3378244963 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nathan Ray Fontenot, Jr., Apdc Po Box 815 Jennings LA 70546-0815 Ph: (337) 824-4963 | Nathan Ray Fontenot, Jr., Apdc 715 N Main St Jennings LA 70546-5311 Ph: (337) 824-4963 |
| NPI Number | 1114262649 |
|---|---|
| Provider Enumeration Date | 12/10/2012 |
| Last Update Date | 12/10/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114262649 | NPI | - | NPPES |
| 18354319 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 3543 (Louisiana) | Primary |
Mitchell M Sonnier Dds Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 Cary Ave, Jennings, LA 70546 Phone: 337-824-9090 Fax: 337-824-9068 |