Healthcare Provider Details

I. General information

NPI: 1952320665
Provider Name (Legal Business Name): RONALD CHARLES LE JEUNE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 PARK AVE
MANDEVILLE LA
70448-4921
US

IV. Provider business mailing address

916 DESIRE ST
NEW ORLEANS LA
70117-6250
US

V. Phone/Fax

Practice location:
  • Phone: 985-624-7400
  • Fax: 985-624-7425
Mailing address:
  • Phone: 504-945-1439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number6930
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: