Provider Demographics
NPI:1508902834
Name:DENTAL HEALTH OF MARRERO, IINC.
Entity Type:Organization
Organization Name:DENTAL HEALTH OF MARRERO, IINC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NOLAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-340-0076
Mailing Address - Street 1:4001 LAPALCO BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2389
Mailing Address - Country:US
Mailing Address - Phone:504-340-0076
Mailing Address - Fax:504-340-0078
Practice Address - Street 1:4001 LAPALCO BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2389
Practice Address - Country:US
Practice Address - Phone:504-340-0076
Practice Address - Fax:504-340-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA27891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty