Provider Demographics
NPI:1073526281
Name:PRUDHOME, DAVID KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KEVIN
Last Name:PRUDHOME
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16606 GREENWELL SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739
Mailing Address - Country:US
Mailing Address - Phone:225-262-4150
Mailing Address - Fax:225-262-8005
Practice Address - Street 1:16606 GREENWELL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739
Practice Address - Country:US
Practice Address - Phone:225-262-4150
Practice Address - Fax:225-262-8005
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice