Healthcare Provider Details

I. General information

NPI: 1225690456
Provider Name (Legal Business Name): HOUMA FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 GRINAGE ST
HOUMA LA
70360-4525
US

IV. Provider business mailing address

219 GRINAGE ST
HOUMA LA
70360-4525
US

V. Phone/Fax

Practice location:
  • Phone: 985-868-5699
  • Fax: 985-223-4221
Mailing address:
  • Phone: 985-868-5699
  • Fax: 985-223-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN A MORGAN JR.
Title or Position: OWNER/DDS
Credential: DDS
Phone: 985-868-5699