Individual
LANE BAZAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
481 MOOSA BLVD, EUNICE, LA 70535-3627
(337) 308-1853
Mailing address
PO BOX 678, PRAIRIEVILLE, LA 70769-0678
(337) 308-1853
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7778
LA
Other
Enumeration date
05/14/2026
Last updated
05/19/2026
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