| NPI | 1154711802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE R FAUST Owner 504-834-1993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5964) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2015-02-03 |