Organization

Rae A. Gauthier, Dds, Llc Dba Ponchatoula Family Dentistry

Dental Clinic/Center in Ponchatoula, LA(View on Map)

Legal Business Name

Rae A. Gauthier, Dds, Llc Dba Ponchatoula Family Dentistry

NPI Number

1215446521

NPI Type

Organization

Enumeration Date

09/29/2017

Specialties

(Taxonomies)

Code

261QD0000X

Primary Taxonomy

Yes

Licenses

State

Louisiana

License Number

5909

Contact
Information

Purpose

Mailing
Location

Address

430 E PINE ST
430 E PINE ST

City

Ponchatoula
Ponchatoula

State

LA
LA

Postal Code

70454-2544
70454-2544

Country

US
US

Telephone Number

(985) 687-3806
(985) 687-3806

Authorized Official

Name

Rae Gauthier

Title or Position

OWNER/DENTIST

Telephone Number

(985) 386-8454

Identifiers

Identifier

1859095

Identifier State

LA

Identifier Issuer

Unknown

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 07/21/2022

Provider Address

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Organization

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