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General NPI Number Information
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NPI Number | 1760521496
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Entity Type | Individual
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Provider Name | KELLY MARIE MEILLEUR DDS
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 2334 GAUSE BLVD E
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City | SLIDELL
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State | LA
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Zip | 70461-4141
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Country | US
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Telephone | 985-645-9555
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Fax | 985-645-9551
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Provider Business Mailing Address
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Address Line | 2334 GAUSE BLVD E
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City | SLIDELL
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State | LA
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Zip | 70461-4141
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Country | US
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Telephone | 985-645-9555
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Fax | 985-645-9551
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 4496
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License Number State | LA
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