Provider Demographics
NPI:1548355035
Name:RICHARD, DANIELLE CELESTE (DDS)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:CELESTE
Last Name:RICHARD
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 1:3502 S CARROLLTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-4508
Mailing Address - Country:US
Mailing Address - Phone:504-410-3051
Mailing Address - Fax:504-410-3038
Practice Address - Street 1:4000 GUS YOUNG AVENUE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802
Practice Address - Country:US
Practice Address - Phone:225-389-8850
Practice Address - Fax:225-389-8853
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1856061Medicaid
LA5606OtherSTATE LIC
LA5606OtherSTATE LIC