# EXCEPTIONAL DENTAL OF MARRERO

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134284789
- **Authorized official:** DR. DARRELL PHILIP BOURG JR. DDS (DENTIST)
- **Authorized official phone:** (504) 232-6624

## Contact information

- **Practice address:** 2521 AMES BLVD STE C, MARRERO, LA 70072-5154
- **Practice address phone:** (504) 340-9696
- **Practice address fax:** (504) 340-7207
- **Mailing address:** 2521 AMES BLVD STE C, MARRERO, LA 70072-5154
- **Mailing address phone:** (504) 340-9696
- **Mailing address fax:** (504) 340-7207

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5312 | LA | Yes |

## Other

- **Enumeration date:** 12/26/2006
- **Last updated:** 12/08/2015