| NPI | 1225235807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGET FABRE Practice Manager 337-984-0403 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: LA 2529) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2025-05-01 |