Healthcare Provider Details

I. General information

NPI: 1033187687
Provider Name (Legal Business Name): RANDY P DUGAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 OLD JEANERETTE RD.
NEW IBERIA LA
70563
US

IV. Provider business mailing address

2217 OLD JEANERETTE RD.
NEW IBERIA LA
70563
US

V. Phone/Fax

Practice location:
  • Phone: 337-365-0816
  • Fax: 337-365-9796
Mailing address:
  • Phone: 337-365-0816
  • Fax: 337-365-9796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3275
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: