Provider Demographics
NPI:1245805183
Name:FRUGE, CECIL FARRELL III (DDS)
Entity Type:Individual
Prefix:DR
First Name:CECIL
Middle Name:FARRELL
Last Name:FRUGE
Suffix:III
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 1:19232 SPYGLASS HILL DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-6724
Mailing Address - Country:US
Mailing Address - Phone:225-439-6671
Mailing Address - Fax:
Practice Address - Street 1:11811 COURSEY BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4490
Practice Address - Country:US
Practice Address - Phone:225-292-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7187122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist