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Organization
CHARLIE P. ILAWAN, DDS, APDC
Active
Organization
CHARLIE P. ILAWAN, DDS, APDC
Active
Other names
Family Dentistry of Bogalusa
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLIE P ILAWAN D.D.S. (OWNER)
(985) 735-7372
Entity
Organization
Contact information
Practice address
400 LOUISIANA AVE, BOGALUSA, LA 70427-3323
(985) 735-7372
(985) 732-5944
Mailing address
400 LOUISIANA AVE, BOGALUSA, LA 70427-3323
(985) 735-7372
(985) 732-5944
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4361
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014606
—
MS
05
—
1880949
—
LA
01
—
971021
UNITED CONCORDIA
LA
Enumeration date
05/10/2007
Last updated
11/04/2008
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