Provider Demographics
NPI:1881708568
Name:WILLIAM R. LEDOUX D.D.S. A.P.D.C.
Entity type:Organization
Organization Name:WILLIAM R. LEDOUX D.D.S. A.P.D.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEDOUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-674-1500
Mailing Address - Street 1:260 DALWILL DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3372
Mailing Address - Country:US
Mailing Address - Phone:985-674-1500
Mailing Address - Fax:985-674-9188
Practice Address - Street 1:260 DALWILL DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3372
Practice Address - Country:US
Practice Address - Phone:985-674-1500
Practice Address - Fax:985-674-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20811223X0400X
LA29931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA437902103DOtherBLUE CROSS BLUE SHIELD
LA116434OtherUNITED CONCORDIA
LA1829935Medicaid
MS05789559Medicaid