MEDICARE: WILLIAM A COUVILLION 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
1	1223P0106X	Oral and Maxillofacial Pathology Dentistry	1694	LA

General Provider Information

NPI Number	:	1740209139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM A COUVILLION D.D.S.

Provider Business Mailing Address
First Line	:	7341 JEFFERSON HWY
Second Line	:	SUITE A
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-8203
Country	:	US
Telephone Number	:	225-926-5301
Fax Number	:	225-924-2677

Provider Business Practice Location Address
First Line	:	7341 JEFFERSON HWY
Second Line	:	SUITE A
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-8203
Country	:	US
Telephone Number	:	225-926-5301
Fax Number	:	225-924-2677

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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