Provider Demographics
NPI:1093711368
Name:LEBLANC, ERIC J (DDS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:LEBLANC
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 1:2285 BENTON RD
Mailing Address - Street 2:SUITE C-100
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111
Mailing Address - Country:US
Mailing Address - Phone:318-742-9333
Mailing Address - Fax:318-742-9394
Practice Address - Street 1:2285 BENTON RD
Practice Address - Street 2:STE C100
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3465
Practice Address - Country:US
Practice Address - Phone:318-742-9333
Practice Address - Fax:318-742-9394
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA22171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry