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General NPI Number Information
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NPI Number | 1326575945
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Entity Type | Organization
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Legal Business Name | EXCEPTIONAL DENTAL OF METAIRIE, LLC
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Dates
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Enumeration Date | 05/13/2017
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 1128 CLEARVIEW PKWY
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City | METAIRIE
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State | LA
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Zip | 70001-3418
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Country | US
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Telephone | 504-900-1195
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Fax |
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Provider Business Mailing Address
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Address Line | 1128 CLEARVIEW PKWY
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City | METAIRIE
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State | LA
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Zip | 70001-3418
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DARRELL BOURG
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Credential |
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Telephone | 504-232-6624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5312
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License Number State | LA
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