Provider Demographics
NPI: | 1003944075 |
---|---|
Name: | AUGILLARD DENTAL GROUP, LLC |
Entity Type: | Organization |
Organization Name: | AUGILLARD DENTAL GROUP, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | TERRENCE |
Authorized Official - Middle Name: | MICHEAL |
Authorized Official - Last Name: | AUGILLARD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 504-947-7700 |
Mailing Address - Street 1: | 3711 FRENCHMEN ST |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW ORLEANS |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 70122-3705 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 504-947-7700 |
Mailing Address - Fax: | 504-947-7702 |
Practice Address - Street 1: | 3711 FRENCHMEN ST |
Practice Address - Street 2: | |
Practice Address - City: | NEW ORLEANS |
Practice Address - State: | LA |
Practice Address - Zip Code: | 70122-3705 |
Practice Address - Country: | US |
Practice Address - Phone: | 504-947-7700 |
Practice Address - Fax: | 504-947-7702 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-01 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
LA | 4463 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Multi-Specialty |