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NPI Code Detail

MEDICARE: DR. CECIL FARRELL FRUGE JR. D.D.S.

MEDICARE: DR. CECIL FARRELL FRUGE JR. D.D.S.
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
11223G0001XGeneral Practice Dentistry4180LA

General Provider Information

NPI Number : 1629143425
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CECIL FARRELL FRUGE JR. D.D.S.
Provider Business Mailing Address
First Line : 11811 COURSEY BLVD
Second Line : SUITE A
City : BATON ROUGE
State : LA
Zip : 70816-4404
Country : US
Telephone Number : 225-292-9700
Fax Number : 225-292-9701
Provider Business Practice Location Address
First Line : 11811 COURSEY BLVD
Second Line : SUITE A
City : BATON ROUGE
State : LA
Zip : 70816-4404
Country : US
Telephone Number : 225-292-9700
Fax Number : 225-292-9701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2006
Last Update Date : 09/22/2010

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