Healthcare Provider Details

I. General information

NPI: 1548503998
Provider Name (Legal Business Name): JONATHON B TURGEON A PROFFESSIONAL DENTAL LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 AIRLINE DR STE B
BOSSIER CITY LA
71111-3173
US

IV. Provider business mailing address

2160 AIRLINE DR STE B
BOSSIER CITY LA
71111-3173
US

V. Phone/Fax

Practice location:
  • Phone: 318-741-6778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5937
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN B TURGEON
Title or Position: OWNER
Credential: DDS
Phone: 318-741-6778