Provider Demographics
NPI:1982060661
Name:CHARLES J ARDOIN II, DDS, LLC
Entity Type:Organization
Organization Name:CHARLES J ARDOIN II, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARDOIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-526-7242
Mailing Address - Street 1:4985 HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70665-7571
Mailing Address - Country:US
Mailing Address - Phone:337-583-2756
Mailing Address - Fax:337-583-9031
Practice Address - Street 1:4985 HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70665-7571
Practice Address - Country:US
Practice Address - Phone:337-583-2756
Practice Address - Fax:337-583-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4041261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental