Provider Demographics
NPI:1023169646
Name:BOUSTANY, FRANCIS EPHREM JR (DDS)
Entity type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:EPHREM
Last Name:BOUSTANY
Suffix:JR
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 1:126 WESTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5484
Mailing Address - Country:US
Mailing Address - Phone:337-993-3600
Mailing Address - Fax:
Practice Address - Street 1:126 WESTFIELD DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5484
Practice Address - Country:US
Practice Address - Phone:337-993-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA27901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1827908Medicaid