Provider Demographics
NPI:1932242112
Name:LEDOUX, MICHAEL J (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:LEDOUX
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 1:100 EMERALD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3610
Mailing Address - Country:US
Mailing Address - Phone:603-352-1993
Mailing Address - Fax:603-352-7747
Practice Address - Street 1:100 EMERALD ST
Practice Address - Street 2:SUITE C
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3610
Practice Address - Country:US
Practice Address - Phone:603-352-1993
Practice Address - Fax:603-352-7747
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH23191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice