Individual
MARK A BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
608 NORTH AVENUE K, CROWLEY, LA 70526
(337) 788-0677
(337) 783-0343
Mailing address
608 NORTH AVENUE K, CROWLEY, LA 70526
(337) 788-0677
(337) 783-0343
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
LA4905
LA
Other
Enumeration date
11/08/2006
Last updated
07/08/2007
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