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General NPI Number Information
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NPI Number | 1982060661
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Entity Type | Organization
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Legal Business Name | CHARLES J ARDOIN II, DDS, LLC
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 4985 HIGHWAY 27 S
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City | SULPHUR
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State | LA
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Zip | 70665-7571
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Country | US
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Telephone | 337-583-2756
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Fax | 337-583-9031
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Provider Business Mailing Address
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Address Line | 4985 HIGHWAY 27 S
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City | SULPHUR
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State | LA
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Zip | 70665-7571
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Country | US
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Telephone | 337-583-2756
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Fax | 337-583-9031
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. KIMBERLY ARDOIN
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Credential |
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Telephone | 337-526-7242
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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 | 4041
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License Number State | LA
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