| NPI | 1164677233 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF DOUGLAS ELLARD Owner/ President 225-924-2010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 3507) |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2008-11-17 |