Provider Demographics
NPI:1801239710
Name:GAUBERT, REYNOLD LOUIS JR (DMD)
Entity type:Individual
Prefix:DR
First Name:REYNOLD
Middle Name:LOUIS
Last Name:GAUBERT
Suffix:JR
Gender:M
Credentials:DMD
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Mailing Address - Street 1:3839 W CONGRESS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6000
Mailing Address - Country:US
Mailing Address - Phone:337-984-1059
Mailing Address - Fax:337-984-2043
Practice Address - Street 1:3839 W CONGRESS ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6000
Practice Address - Country:US
Practice Address - Phone:337-984-1059
Practice Address - Fax:337-984-2043
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA25331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics