Provider Demographics
NPI:1447998901
Name:CORMIER, LANI HUVAL (DDS)
Entity type:Individual
Prefix:DR
First Name:LANI
Middle Name:HUVAL
Last Name:CORMIER
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 1:200 MAGNOLIA FARMS RD
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-5917
Mailing Address - Country:US
Mailing Address - Phone:337-277-4171
Mailing Address - Fax:
Practice Address - Street 1:1601 KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6109
Practice Address - Country:US
Practice Address - Phone:337-704-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA73071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice