| NPI | 1104243054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH RICHARD DUBOIS Owner 504-241-8457 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 2809) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2014-03-29 |