Provider Demographics
NPI:1144711359
Name:HEBERT, MELANIE JORDAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:JORDAN
Last Name:HEBERT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 GATESMERE CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5425
Mailing Address - Country:US
Mailing Address - Phone:337-852-3817
Mailing Address - Fax:
Practice Address - Street 1:116 E TEXAS AVE
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-5822
Practice Address - Country:US
Practice Address - Phone:337-334-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6851122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist