Provider Demographics
NPI:1780019851
Name:BABINEAUX, BROOKS (DDS)
Entity Type:Individual
Prefix:
First Name:BROOKS
Middle Name:
Last Name:BABINEAUX
Suffix:
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 1:621 RUE DE ONETTA
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2164
Mailing Address - Country:US
Mailing Address - Phone:337-367-3739
Mailing Address - Fax:337-369-3374
Practice Address - Street 1:1009 CHARITY ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-5302
Practice Address - Country:US
Practice Address - Phone:337-893-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA63851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1863858Medicaid