Provider Demographics
NPI:1629143425
Name:FRUGE, CECIL FARRELL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CECIL
Middle Name:FARRELL
Last Name:FRUGE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11811 COURSEY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4404
Mailing Address - Country:US
Mailing Address - Phone:225-292-9700
Mailing Address - Fax:225-292-9701
Practice Address - Street 1:11811 COURSEY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4404
Practice Address - Country:US
Practice Address - Phone:225-292-9700
Practice Address - Fax:225-292-9701
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA41801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice