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Individual
JOHNNIE BREAUX
Active
Individual
JOHNNIE BREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4414
LA
1223G0001X
General Practice Dentistry
4690
TN
Other
Enumeration date
12/15/2006
Last updated
04/05/2012
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