Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2214 | LA |
Y | 1223E0200X | Endodontist | 2214 | LA |
NPI | 1093997389 |
---|---|
Provider Name | Dr. Billie Griggs Jeansonne |
First Address | New Orleans, LA 70119-2714 |
Second Address | New Orleans, LA 70119-2714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2007 |
Last Update Date | 29/11/2007 |