Provider Demographics
NPI:1407161714
Name:LEDOUX, ANDRE CHRISTIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:CHRISTIAN
Last Name:LEDOUX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17361 SW 290TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-2588
Mailing Address - Country:US
Mailing Address - Phone:904-472-6095
Mailing Address - Fax:
Practice Address - Street 1:7231 SW 63RD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4809
Practice Address - Country:US
Practice Address - Phone:305-667-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19058122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery