Provider Demographics
NPI:1861656068
Name:LEACH, LAUREN ARDOIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ARDOIN
Last Name:LEACH
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 1:9709 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-7801
Mailing Address - Country:US
Mailing Address - Phone:225-271-8553
Mailing Address - Fax:225-271-8894
Practice Address - Street 1:9709 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-7801
Practice Address - Country:US
Practice Address - Phone:225-271-8553
Practice Address - Fax:225-271-8894
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice