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Organization
DARRELL P. BOURG JR. DDS
Active
Organization
DARRELL P. BOURG JR. DDS
Active
Other names
Louisiana Dental Spa
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARRELL PAUL BOURG JR. DDS (DENTIST)
(504) 340-9696
Entity
Organization
Contact information
Practice address
2521 AMES BLVD STE C, MARRERO, LA 70072-5154
(504) 340-9696
(504) 340-7207
Mailing address
21 SAN CARLOS AVE, JEFFERSON, LA 70121-2240
(504) 621-6338
(504) 340-7207
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5747
LA
Other
Enumeration date
12/20/2006
Last updated
08/22/2020
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