| NPI | 1003970682 |
|---|---|
| Doing Business As | LOUISIANA DENTAL SPA |
| Entity Type | Organization |
| Authorized Contact | DARRELL PAUL BOURG Dentist 504-232-6624 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5312) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2020-08-22 |