Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6163 | LA |
NPI | 1003100454 |
---|---|
Provider Name | Troy A Babb |
First Address | Deville, LA 71328-9232 |
Second Address | Alexandria, LA 71301-3432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2011 |
Last Update Date | 02/06/2011 |