MEDICARE: DR. JACQUE DORAN LABRY SR. DDS

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	6450	LA

General Provider Information

NPI Number	:	1619384526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUE DORAN LABRY SR. DDS

Provider Business Mailing Address
First Line	:	225 CHIMNEY ROCK BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-8065
Country	:	US
Telephone Number	:	337-322-2513
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 CHIMNEY ROCK BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-8065
Country	:	US
Telephone Number	:	337-322-2513
Fax Number	:

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

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	07/14/2014

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