Provider Demographics
NPI:1669733390
Name:BOYETTE, HEATHER NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:NICOLE
Last Name:BOYETTE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:DELASALLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6061 PINNACLE PKWY
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-9193
Mailing Address - Country:US
Mailing Address - Phone:985-327-6501
Mailing Address - Fax:985-327-6506
Practice Address - Street 1:6061 PINNACLE PKWY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-9193
Practice Address - Country:US
Practice Address - Phone:985-327-6501
Practice Address - Fax:985-327-6506
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2025-09-02
Deactivation Date:2025-05-29
Deactivation Code:
Reactivation Date:2025-07-21
Provider Licenses
StateLicense IDTaxonomies
MSPTA4741225200000X
LA76591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant