Provider Demographics
NPI:1578089603
Name:ARDOIN-KENNEDY LLC
Entity Type:Organization
Organization Name:ARDOIN-KENNEDY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARDOIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-948-9878
Mailing Address - Street 1:2351 LARKSPUR LANE
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570
Mailing Address - Country:US
Mailing Address - Phone:337-948-9878
Mailing Address - Fax:332-948-9097
Practice Address - Street 1:203 A ENERGY PARKWAY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-234-1780
Practice Address - Fax:337-234-1723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARDOIN-KENNEDY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1842559Medicaid