Individual
ERICA BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
520 N 12TH ST, RICHMOND, VA 23298-5064
(804) 828-9190
Mailing address
618 S DESTREHAN AVE, DESTREHAN, LA 70047-5132
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0442000493
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/09/2023
Last updated
06/21/2023
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