Provider Demographics
NPI:1003944075
Name:AUGILLARD DENTAL GROUP, LLC
Entity type:Organization
Organization Name:AUGILLARD DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:MICHEAL
Authorized Official - Last Name:AUGILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-947-7700
Mailing Address - Street 1:3711 FRENCHMEN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-3705
Mailing Address - Country:US
Mailing Address - Phone:504-947-7700
Mailing Address - Fax:504-947-7702
Practice Address - Street 1:3711 FRENCHMEN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-3705
Practice Address - Country:US
Practice Address - Phone:504-947-7700
Practice Address - Fax:504-947-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4463122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty