Organization
EXCEPTIONAL DENTAL OF MARRERO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARRELL PHILIP BOURG JR. DDS (DENTIST)
(504) 232-6624
Entity
Organization
Contact information
Practice address
2521 AMES BLVD STE C, MARRERO, LA 70072-5154
(504) 340-9696
(504) 340-7207
Mailing address
2521 AMES BLVD STE C, MARRERO, LA 70072-5154
(504) 340-9696
(504) 340-7207
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5312
LA
Other
Enumeration date
12/26/2006
Last updated
12/08/2015
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