LAKE AREA DENTISTRY-DEQUINCY, LLC (NPI# 1598209207) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598209207 |
| Entity Type | Organization |
| Organization Name | LAKE AREA DENTISTRY-DEQUINCY, LLC |
| Other Organization Name | LAKE AREA DENTISTRY |
| Practice Address |
824 W 4th St Dequincy LA 70633 |
| Practice Telephone | 3377866221 |
| Mailing Telephone | 3377866221 |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2016-12-14 |
| Authorized Official Name | DR. JEFFERY ALLEN HENNIGAN (OWNER/DENTIST) |
| Authorized Official Telephone | 3377866221 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
LA-6269 | LA | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Lake Area Dentistry | Doing Business As Name - Organization |
| Street Address |
824 W 4TH ST |
| City | DEQUINCY |
| State | LA |
| Zip Code | 70633 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710901053 | Peter T. Bayles | Dentist | 824 W 4th St, Dequincy, LA 70633-3321 | 2006-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508036690 | John Craig Crawford | Emergency Medicine | 14925 Hwy 27, Phelps Correctional Center, Dequincy, LA 70633 | 2008-03-05 |
| 1306993191 | Kevin Michael Hamilton | Dentist | 202 S. Holly Street, Dequincy, LA 70633 | 2007-01-04 |
| 1639118078 | St Michael Pfu LLC | Skilled Nursing Facility | 602 N Division St, Dequincy, LA 70633-3129 | 2006-06-04 |
| 1548328115 | Jalal Joudeh | Internal Medicine | 601 W 4th St, Dequincy, LA 70633-3301 | 2006-12-05 |
| 1861425324 | Jalal Joudeh | Internal Medicine | 601 W 4th St, Dequincy, LA 70633-3301 | 2006-07-08 |
| 1285149690 | Jody Olmsted Arnold | Pharmacist | 702 W 4th St, Dequincy, LA 70633-3304 | 2017-12-07 |
| 1790227478 | Shanelle Buxton | Pharmacist | 702 W 4th St, Dequincy, LA 70633-3304 | 2016-11-10 |
| 1356771463 | Freds Stores of Tennessee Inc. | Pharmacy | 702 W 4th St, Dequincy, LA 70633-3304 | 2013-11-26 |
| 1881877629 | Debra H. Harville | Specialist | 112 Chavis Sq, Dequincy, LA 70633-3345 | 2007-12-16 |
| 1831560390 | Charles James Johnson | Pharmacist | 300 W. 4th Street, Dequincy, LA 70633-3404 | 2015-10-09 |
| Find all providers in zip 70633 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
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| 1851912711 | Covington Empower Orthodontics LLC - Dr Timothy M Poyadou Jr | Clinic/Center | 100 Tyler Sq Ste 4, Covington, LA 70433-3060 | 2020-05-01 |
| 1699314799 | Peach Tree Dental West Monroe, LLC | Clinic/Center | 3422 Cypress St, West Monroe, LA 71291-7310 | 2020-01-06 |
| 1538706015 | Exceptional Dental of Uptown, LLC | Clinic/Center | 5300 Tchoupitoulas St Ste F4, New Orleans, LA 70115-1963 | 2019-12-04 |
| 1447897186 | Affordable Smiles of Hammond, LLC | Clinic/Center | 2804 W Thomas St, Hammond, LA 70401-2841 | 2019-12-02 |
| 1528615887 | Benjamin A. Beach Dds and Ross H. Dies Dds Midcity, LLC | Clinic/Center | 8510 Line Ave Ste A, Shreveport, LA 71106-6119 | 2019-08-21 |
| 1295380418 | W. J. Dudley Denture Consultants | Clinic/Center | 4354 Pines Rd, Shreveport, LA 71119-7738 | 2019-08-05 |
| 1689226946 | Silver Lining Dentistry & Co. | Clinic/Center | 2305 West Esplanade Suit U, Kenner, LA 70065 | 2019-07-16 |
| 1790337632 | West Baton Rouge Dental Associates, LLC | Clinic/Center | 6572 Hwy 1 South, Addis, LA 70710 | 2019-07-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.