Individual
DR. JOHNNY J BOUZIGARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
15384 W MAIN ST, CUT OFF, LA 70345-3411
(985) 632-4394
(985) 632-2894
Mailing address
15384 W MAIN ST, CUT OFF, LA 70345-3411
(985) 632-4394
(985) 632-2894
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2042
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1820423
—
LA
01
—
2042
STATE LICENSE NUMBER
LA
Enumeration date
01/27/2007
Last updated
07/09/2007
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