| NPI | 1598060642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGETTE MICHELLE VIDRINE Owner/Manager 337-942-3441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5885) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6040) |
| 124Q00000X Dental Hygienist | |
| 126800000X Dental Assistant | |
| Enumeration Date | 2011-01-21 |
| Last Update Date | 2011-01-21 |