Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 2217 | LA |
NPI | 1093711368 |
---|---|
Provider Name | Eric J Leblanc |
First Address | Bossier City, LA 71111 |
Second Address | Bossier City, LA 71111-3465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 08/07/2007 |