| NPI | 1194035352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRELL PHILIP BOURG Dentist/Owner 504-469-6333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: LA 5312) |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2015-12-08 |