| Doctor Name: | GANTT NICHOLSON DEJEAN |
| NPI Number: | 1083752422 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DDS MS |
| License Number: | 2435 |
| Business Practice Address: | 1604 Kerr St Suite 101 Opelousas, LA - 70570 |
| Business Phone Number: | 3379488253 |
| Business Fax Number: | 3379428161 |
| Mailing Address: | 1604 Kerr St, Suite 101 OPELOUSAS |
| State: | LA |
| Postal Code: | 70570 |
| Phone Number: | 3379488253 |
| Fax Number: | 3379428161 |
| NPI Enumeration Date: | 02/01/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | 2435 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |