1881708568 NPI number — WILLIAM R. LEDOUX D.D.S. A.P.D.C.

Table of content: (NPI 1881708568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881708568 NPI number — WILLIAM R. LEDOUX D.D.S. A.P.D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM R. LEDOUX D.D.S. A.P.D.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881708568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 DALWILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70471-3372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-674-1500
Provider Business Mailing Address Fax Number:
985-674-9188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 DALWILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANDEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70471-3372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-674-1500
Provider Business Practice Location Address Fax Number:
985-674-9188
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEDOUX
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
985-674-1500

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  2993 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223X0400X , with the licence number: 2081 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 437902103D . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 116434 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1829935 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05789559 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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