Provider Demographics
NPI:1326342254
Name:DROUILLARD, BRIAN C (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
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 1:206 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4017
Mailing Address - Country:US
Mailing Address - Phone:405-707-0600
Mailing Address - Fax:
Practice Address - Street 1:745 E JOYCE BLVD
Practice Address - Street 2:SUITE 221
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6375
Practice Address - Country:US
Practice Address - Phone:479-443-1849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN92121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice