Individual
MICHAEL JOHN PENEGUY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
824 RIDGEFIELD RD, THIBODAUX, LA 70301-2726
(985) 446-8815
Mailing address
PO BOX 630, THIBODAUX, LA 70302-0630
(985) 446-8815
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5203
LA
Other
Enumeration date
08/01/2006
Last updated
07/08/2007
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