| NPI | 1003083130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK P DEVEREUX Owner 504-684-0079 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: LA 3676) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2013-02-28 |