Provider Demographics
NPI:1609671627
Name:AMBASSADOR FAMILY DENTISTRY
Entity type:Organization
Organization Name:AMBASSADOR FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-981-9923
Mailing Address - Street 1:3233 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-7214
Mailing Address - Country:US
Mailing Address - Phone:337-254-4875
Mailing Address - Fax:337-981-9983
Practice Address - Street 1:3233 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-7214
Practice Address - Country:US
Practice Address - Phone:337-254-4875
Practice Address - Fax:337-981-9983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental