| NPI | 1568720159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGET PAGE DEROUEN Administrative Team Leader 337-233-5375 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2014-01-14 |