| NPI | 1134284789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRELL PHILIP BOURG Dentist 504-232-6624 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5312) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2015-12-08 |