| Organization Name: | NATHAN RAY FONTENOT, JR., APDC |
| NPI Number: | 1114262649 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NATHAN RAY FONTENOT (OWNER/DENTIST) |
| Mailing Address: | 715 N Main St Jennings |
| State: | LA US |
| Postal Code: | 705465311 |
| Phone Number: | 3378244963 |
| Fax Number: | 3378244961 |
| NPI Enumeration Date: | 12/10/2012 |
| NPI Last Update Date: | 12/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 3543 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |