| NPI | 1366829673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD A LACOUR Doctor 225-757-8450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: LA 5037) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 2798) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2015-05-06 |