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General NPI Number Information
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NPI Number | 1912460437
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Entity Type | Organization
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Legal Business Name | BUMGARDNER FAMILY DENTAL, APDC
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 4306 N. UNIVERSITY
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City | CARENCRO
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State | LA
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Zip | 70520
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Country | US
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Telephone | 337-896-3062
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Fax |
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Provider Business Mailing Address
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Address Line | 4306 N. UNIVERSITY
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City | CARENCRO
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State | LA
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Zip | 70520
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Country | US
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Telephone | 337-896-3062
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF BUMGARDNER FAMILY DEN
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Name | DR. BENJAMIN JOSEPH BUMGARDNER
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Credential | D.D.S.
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Telephone | 337-896-3062
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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 |
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License Number State |
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