Provider Demographics
NPI:1578856514
Name:DAIGLE, LAURI BREAUD (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURI
Middle Name:BREAUD
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LAURI
Other - Middle Name:NICHOLE
Other - Last Name:BREAUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2009 POLK ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-6020
Mailing Address - Country:US
Mailing Address - Phone:985-665-1550
Mailing Address - Fax:
Practice Address - Street 1:5683 HIGHWAY 311
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5595
Practice Address - Country:US
Practice Address - Phone:985-868-5699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6151122300000X, 1223G0001X
AL5889 C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist