Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 6962 | LA |
NPI | 1063186393 |
---|---|
Provider Name | Camille Laird |
First Address | Baton Rouge, LA 70820-4257 |
Second Address | Prairieville, LA 70769-4248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2021 |
Last Update Date | 02/08/2021 |