| NPI | 1134493653 |
|---|---|
| Doing Business As | PARK AVENUE DENTAL |
| Entity Type | Organization |
| Authorized Contact | MICHAEL JOSEPH BOUDREAUX Owner 985-209-9338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5906) |
| Enumeration Date | 2012-03-01 |
| Last Update Date | 2012-03-01 |