MEDICARE: CHARLES J ARDOIN II, DDS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	4041	LA

General Provider Information

NPI Number	:	1982060661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES J ARDOIN II, DDS, LLC

Provider Business Mailing Address
First Line	:	4985 HIGHWAY 27 S
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70665-7571
Country	:	US
Telephone Number	:	337-583-2756
Fax Number	:	337-583-9031

Provider Business Practice Location Address
First Line	:	4985 HIGHWAY 27 S
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70665-7571
Country	:	US
Telephone Number	:	337-583-2756
Fax Number	:	337-583-9031

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. KIMBERLY ARDOIN
Credential	:
Telephone Number	:	337-526-7242

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	01/11/2016

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