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General NPI Number Information
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NPI Number | 1922379858
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Entity Type | Organization
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Legal Business Name | JAMES A. MOREAU JR., D.D.S.
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Dates
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Enumeration Date | 01/24/2012
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 7007 HIGHWAY 190 EAST SERVICE RD
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City | COVINGTON
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State | LA
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Zip | 70433-4955
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Country | US
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Telephone | 985-809-7645
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Fax | 985-893-2485
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Provider Business Mailing Address
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Address Line | 7007 HIGHWAY 190 EAST SERVICE RD
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City | COVINGTON
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State | LA
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Zip | 70433-4955
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Country | US
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Telephone | 985-809-7645
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Fax | 985-893-2485
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JAMES A. MOREAU JR.
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Credential | D.D.S.
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Telephone | 985-809-7645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3441
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License Number State | LA
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