Provider Demographics
NPI:1194218263
Name:LEBLANC, MICHAEL F JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:LEBLANC
Suffix:JR
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 1:1101 ROBERT BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2081
Mailing Address - Country:US
Mailing Address - Phone:985-641-8058
Mailing Address - Fax:
Practice Address - Street 1:1101 ROBERT BLVD STE A
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2081
Practice Address - Country:US
Practice Address - Phone:985-641-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA68521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice