Provider Demographics
NPI:1093748972
Name:DUBOIS, KENNETH RICHARD II (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RICHARD
Last Name:DUBOIS
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 20TH ST STE H
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4900
Mailing Address - Country:US
Mailing Address - Phone:504-834-1993
Mailing Address - Fax:504-834-1620
Practice Address - Street 1:5760 HAYNE BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-1252
Practice Address - Country:US
Practice Address - Phone:504-241-8457
Practice Address - Fax:504-241-8450
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA28091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice