Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 3235 | LA |
NPI | 1003919184 |
---|---|
Provider Name | Mr. Lionel Ted Ardoin |
First Address | Ville Platte, LA 70586 |
Second Address | Ville Platte, LA 70586 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1832359 | (05) | LA |