Provider Demographics
NPI:1861921355
Name:ST. ETIENNE, CANDICE DONIELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:DONIELLE
Last Name:ST. ETIENNE
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 1:3932 HIGHWAY 90 W
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:LA
Mailing Address - Zip Code:70094-2648
Mailing Address - Country:US
Mailing Address - Phone:504-341-4006
Mailing Address - Fax:
Practice Address - Street 1:3932 HIGHWAY 90 W
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:LA
Practice Address - Zip Code:70094-2648
Practice Address - Country:US
Practice Address - Phone:504-341-4006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC89491223G0001X
LA67771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice