# CHARLIE P. ILAWAN, DDS, APDC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Family Dentistry of Bogalusa
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578777108
- **Authorized official:** DR. CHARLIE P ILAWAN D.D.S. (OWNER)
- **Authorized official phone:** (985) 735-7372

## Contact information

- **Practice address:** 400 LOUISIANA AVE, BOGALUSA, LA 70427-3323
- **Practice address phone:** (985) 735-7372
- **Practice address fax:** (985) 732-5944
- **Mailing address:** 400 LOUISIANA AVE, BOGALUSA, LA 70427-3323
- **Mailing address phone:** (985) 735-7372
- **Mailing address fax:** (985) 732-5944

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4361 | LA | Yes |

## Other

- **Enumeration date:** 05/10/2007
- **Last updated:** 11/04/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 09014606 | — | MS |
| 05 | — | 1880949 | — | LA |
| 01 | — | 971021 | UNITED CONCORDIA | LA |