Individual
DR. JACEE BLADES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2030 N CAUSEWAY BLVD, MANDEVILLE, LA 70471-3116
(985) 626-3338
Mailing address
2030 N CAUSEWAY BLVD, MANDEVILLE, LA 70471-3116
(985) 626-3338
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7108
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7108
LA STATE BOARD OF DENTISTRY
LA
Enumeration date
06/24/2020
Last updated
06/24/2020
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