Provider Demographics
NPI:1730497942
Name:C FARRELL FRUGE JR DDS
Entity Type:Organization
Organization Name:C FARRELL FRUGE JR DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:FARRELL
Authorized Official - Last Name:FRUGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-292-9700
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:70816-4490
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:70816-4490
Practice Address - Country:US
Practice Address - Phone:225-292-9700
Practice Address - Fax:225-292-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4180335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6443140001Medicare NSC