LAKE AREA DENTISTRY-CARLYSS (NPI# 1043706252) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043706252 |
| Entity Type | Organization |
| Organization Name | LAKE AREA DENTISTRY-CARLYSS |
| Practice Address |
4985 Highway 27 S Sulphur LA 70665-7571 |
| Practice Telephone | 3375832756 |
| Mailing Telephone | 3375832756 |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2018-07-11 |
| Authorized Official Name | DR. JEFFERY HENNIGAN (OWNER) |
| Authorized Official Telephone | 3374788470 |
| 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 |
| Street Address |
4985 HIGHWAY 27 S |
| City | SULPHUR |
| State | LA |
| Zip Code | 70665-7571 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174612998 | Charles James Ardoin II | Dentist | 4985 Highway 27 S, Sulphur, LA 70665-7571 | 2006-10-12 |
| 1982060661 | Charles J Ardoin II, Dds, LLC | Clinic/Center | 4985 Highway 27 S, Sulphur, LA 70665-7571 | 2016-01-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588182489 | Chance Michael Arceneaux | Nurse Practitioner | 2492 South Cities Service Hwy Suite 1, Sulphur, LA 70665 | 2017-08-31 |
| 1669012423 | Tiffany Kathleen Gibbs | Nurse Practitioner | 2492 S Cities Service Hwy Ste 1, Sulphur, LA 70665-6497 | 2020-01-09 |
| 1972642668 | Thomas W. Moran | Physician Assistant | 2492 S Cities Service Hwy, Suite 1, Sulphur, LA 70665-6497 | 2007-02-06 |
| 1104172154 | Louisiana Occupational Medicine and Safety Institute | Clinic/Center | 2492 S Cities Service Hwy, Suite 2, Sulphur, LA 70665-6497 | 2012-07-27 |
| 1497225825 | Ashleigh Clark | Advanced Practice Midwife | 333 Leawood Ave, Sulphur, LA 70665-7030 | 2018-11-28 |
| 1467760009 | James Dant Hughes | Physical Therapist | 3550 Carlyss Dr, Sulphur, LA 70665-7203 | 2010-09-16 |
| 1558726430 | Frankie Reed | Counselor | 564 Edson St, Sulphur, LA 70665-7430 | 2015-12-21 |
| 1902432453 | Jennifer Cook | Behavioral Analyst | 2516 Riley St, Sulphur, LA 70665-7550 | 2020-03-17 |
| 1063041770 | Jc Center | Behavioral Analyst | 2516 Riley St, Sulphur, LA 70665-7550 | 2020-04-04 |
| 1770126609 | Jonathon Kasey Hardy | Physician Assistant | 1125 Point Rd, Sulphur, LA 70665-7693 | 2019-10-23 |
| Find all providers in zip 70665 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730679606 | Sulphur Dentistry & Braces | Clinic/Center | 2611 W Broadway Ave, Sulphur, OK 73086-6518 | 2018-05-15 |
| 1982060661 | Charles J Ardoin II, Dds, LLC | Clinic/Center | 4985 Highway 27 S, Sulphur, LA 70665-7571 | 2016-01-11 |
| 1508952763 | Dr Richard J Martin A Professional Corporation | Clinic/Center | 1621 Beglis Pkwy, Sulphur, LA 70663-5906 | 2006-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760082952 | Jimani Blackwell Dds LLC | Clinic/Center | 8015 Maple St, New Orleans, LA 70118-2738 | 2020-10-28 |
| 1578185096 | Dr. Raymond Poirrier Dds LLC | Clinic/Center | 1968 N Highway 190 Ste 11a, Covington, LA 70433-5158 | 2020-05-07 |
| 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.