Provider Demographics
NPI:1609071968
Name:LEROUX, BRYNN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYNN
Middle Name:L
Last Name:LEROUX
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:PO BOX 77758
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-7758
Mailing Address - Country:US
Mailing Address - Phone:225-924-6622
Mailing Address - Fax:225-926-3384
Practice Address - Street 1:4607 SHERWOOD COMMON BLVD
Practice Address - Street 2:STE 100
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4295
Practice Address - Country:US
Practice Address - Phone:225-924-6622
Practice Address - Fax:225-926-3384
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1858081Medicaid