Individual
MR. KENNETH R DUBOIS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1204 N BROAD ST., NEW ORLEANS, LA 70119
(504) 821-2545
(504) 304-1446
Mailing address
1204 N BROAD ST., NEW ORLEANS, LA 70119
(504) 821-2545
(504) 304-1446
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5997
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1859974
—
LA
Enumeration date
03/18/2009
Last updated
11/08/2016
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