| 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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