Individual
CHARLES GRADY HORNSBY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5227 FLANDERS DR, BATON ROUGE, LA 70808-9169
(225) 769-3600
(225) 767-3275
Mailing address
5227 FLANDERS DR, BATON ROUGE, LA 70808-9169
(225) 769-3600
(225) 767-3275
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2719
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1827193
—
LA
01
—
F2281
BCBS OF LA
LA
Enumeration date
03/09/2006
Last updated
07/08/2007
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