Provider Demographics
NPI:1508995291
Name:BOUDREAUX, SCOTT CHRISTOPHER (RDH)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:CHRISTOPHER
Last Name:BOUDREAUX
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 KETTLE CT
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-5183
Mailing Address - Country:US
Mailing Address - Phone:337-839-8992
Mailing Address - Fax:
Practice Address - Street 1:510 GUILBEAU RD
Practice Address - Street 2:SUITE C-2
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-8400
Practice Address - Country:US
Practice Address - Phone:337-993-0977
Practice Address - Fax:337-993-0978
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3064124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist