Provider Demographics
NPI:1104850817
Name:DROUILLARD, PETER NOEL VINCENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:NOEL VINCENT
Last Name:DROUILLARD
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 1:1811 ARMY BLVD STE 2018
Mailing Address - Street 2:
Mailing Address - City:JBSA FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-2686
Mailing Address - Country:US
Mailing Address - Phone:210-221-0835
Mailing Address - Fax:
Practice Address - Street 1:1811 ARMY BLVD STE 2018
Practice Address - Street 2:
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-2686
Practice Address - Country:US
Practice Address - Phone:210-221-0835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022368122300000X, 1223G0001X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice