| Ellis D. Braud And Fred A. Tenney | |
|
810 Bayou Ln Thibodaux LA 70301-4906 | |
| (985) 446-2888 | |
| (985) 447-1007 |
| Full Name | Ellis D. Braud And Fred A. Tenney |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 810 Bayou Ln, Thibodaux, Louisiana |
| Authorized Official Name and Position | Ellis David Braud (PRESIDENT) |
| Authorized Official Contact | 9854462888 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellis D. Braud And Fred A. Tenney 810 Bayou Ln Thibodaux LA 70301-4906 Ph: (985) 446-2888 | Ellis D. Braud And Fred A. Tenney 810 Bayou Ln Thibodaux LA 70301-4906 Ph: (985) 446-2888 |
| NPI Number | 1275061079 |
|---|---|
| Provider Enumeration Date | 05/24/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275061079 | NPI | - | NPPES |
| 29633 | Medicaid | LA | |
| 29215 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Louisiana) | Primary |
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