MEDICARE: DR. ANDRE CHRISTIAN LEDOUX DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN19058	FL
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN19058	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407161714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRE CHRISTIAN LEDOUX DMD

Provider Business Mailing Address
First Line	:	17361 SW 290TH ST
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33030-2588
Country	:	US
Telephone Number	:	904-472-6095
Fax Number	:

Provider Business Practice Location Address
First Line	:	7231 SW 63RD AVE
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-4809
Country	:	US
Telephone Number	:	305-667-1191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2010
Last Update Date	:	08/03/2021

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