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Organization

VINTAGE L DELAHOUSSAYE DDS APDC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
VINTAGE LEBLANC DDS (OWNER/PRESIDENT)
(337) 234-8788
Entity
Organization

Contact information

Practice address
1144 COOLIDGE BLVD STE A, LAFAYETTE, LA 70503-2622
(337) 234-8788
Mailing address
107 REGENCY SQ, LAFAYETTE, LA 70508-4221
(337) 739-3396

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5523
LA

Other

Enumeration date
01/22/2018
Last updated
04/19/2023
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