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General NPI Number Information
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NPI Number | 1548970189
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Entity Type | Individual
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Provider Name | JORDAN BROUGHTON BOONE DMD
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Gender | Female
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 140 VETERANS BLVD
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-5100
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Country | US
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Telephone | 225-800-4495
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Fax |
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Provider Business Mailing Address
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Address Line | 29138 S REDWOOD DR
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-3146
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Country | US
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Telephone | 601-620-9111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 7390
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License Number State | LA
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