Louisiana Dental Spa | |
2521 Ames Blvd Ste C Marrero LA 70072-5154 | |
(504) 340-9696 | |
(504) 340-7207 |
Full Name | Louisiana Dental Spa |
---|---|
Speciality | Dentist - General Practice |
Location | 2521 Ames Blvd Ste C, Marrero, Louisiana |
Authorized Official Name and Position | Darrell Paul Bourg (DENTIST) |
Authorized Official Contact | 5043409696 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Louisiana Dental Spa 21 San Carlos Ave Jefferson LA 70121-2240 Ph: (504) 621-6338 | Louisiana Dental Spa 2521 Ames Blvd Ste C Marrero LA 70072-5154 Ph: (504) 340-9696 |
NPI Number | 1740344225 |
---|---|
Provider Enumeration Date | 12/20/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740344225 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 5747 (Louisiana) | Primary |
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› Verified 5 days ago
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