Individual
MRS. KIMBERLY EASLEY BODDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
104 S SPRUCE ST, HAMMOND, LA 70403-4136
(985) 542-1997
Mailing address
104 S SPRUCE ST, HAMMOND, LA 70403-4136
(985) 542-1997
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
5561
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1855618
—
LA
Enumeration date
03/08/2007
Last updated
07/08/2009
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