Organization
EXCEPTIONAL DENTAL OF KENNER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARRELL PHILIP BOURG JR. DDS (DENTIST/OWNER)
(504) 469-6333
Entity
Organization
Contact information
Practice address
1305 W ESPLANADE AVE, KENNER, LA 70065-2744
(504) 469-6333
(504) 469-6355
Mailing address
1305 W ESPLANADE AVE, KENNER, LA 70065-2744
(504) 469-6333
(504) 469-6355
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
5312
LA
Other
Enumeration date
10/20/2010
Last updated
12/08/2015
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