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General NPI Number Information
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NPI Number | 1942550470
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Entity Type | Organization
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Legal Business Name | EDMOND J. GANUCHEAU, JR. DDS, APDC
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 2825 HOUMA BLVD
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City | METAIRIE
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State | LA
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Zip | 70006-6635
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Country | US
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Telephone | 504-887-3121
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Fax |
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Provider Business Mailing Address
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Address Line | 2825 HOUMA BLVD
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City | METAIRIE
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State | LA
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Zip | 70006-6635
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Country | US
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Telephone | 504-887-3121
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRYON C GANUCHEAU
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Credential | DDS
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Telephone | 504-887-3121
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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 | 5403
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4959
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License Number State | LA
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