Healthcare Provider Details

I. General information

NPI: 1053664573
Provider Name (Legal Business Name): JIMMY A BABINEAUX JR DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 W PINHOOK RD
LAFAYETTE LA
70503-3159
US

IV. Provider business mailing address

1534 W PINHOOK RD
LAFAYETTE LA
70503-3159
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-3214
  • Fax:
Mailing address:
  • Phone: 337-234-3214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number5880
License Number StateLA

VIII. Authorized Official

Name: DR. JIMMY A BABINEAUX JR.
Title or Position: DENTIST
Credential: DDS
Phone: 337-234-3214