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Individual

DR. CARLY RACHELLE BOUDREAUX

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
1709 HERITAGE HILLS DR, WASHINGTON, MO 63090-4621
(636) 238-3520
Mailing address
114 METALS DR, YOUNGSVILLE, LA 70592-5812
(337) 654-6866

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2021024201
MO
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
05/14/2019
Last updated
08/05/2021
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