Provider Demographics
NPI:1730962234
Name:MICHAELIS AND LEDOUX ORTHODONTICS LLC
Entity type:Organization
Organization Name:MICHAELIS AND LEDOUX ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MICHAELIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-674-1500
Mailing Address - Street 1:PO BOX 1582
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-1582
Mailing Address - Country:US
Mailing Address - Phone:985-674-1500
Mailing Address - Fax:985-674-9188
Practice Address - Street 1:260 DALWILL DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3372
Practice Address - Country:US
Practice Address - Phone:985-674-1500
Practice Address - Fax:985-674-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty