Provider Demographics
NPI:1821156639
Name:LEBON, BRIAN GERARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:GERARD
Last Name:LEBON
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 1:4401A TRANSCONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2131
Mailing Address - Country:US
Mailing Address - Phone:504-455-5316
Mailing Address - Fax:504-455-5315
Practice Address - Street 1:4401A TRANSCONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2131
Practice Address - Country:US
Practice Address - Phone:504-455-5316
Practice Address - Fax:504-455-5315
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA31661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA153776OtherUNITED CONCORDIA INSURANC
LAA2021OtherBLUECROSS BLUESHIELD LA