Provider Demographics
NPI:1437483054
Name:OUBRE, CECILIA CHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:CHAN
Last Name:OUBRE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 RYAN ST
Mailing Address - Street 2:SUITE 26
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7393
Mailing Address - Country:US
Mailing Address - Phone:318-219-5159
Mailing Address - Fax:
Practice Address - Street 1:2802 RYAN ST
Practice Address - Street 2:SUITE 26
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7393
Practice Address - Country:US
Practice Address - Phone:318-219-5159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1812480Medicaid