Organization
LA VIE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES JAMES WAGUESPACK DDS (OWNER/DENTIST)
(985) 532-5303
Entity
Organization
Contact information
Practice address
109 JOHNNY DUFRENE DR, RACELAND, LA 70394-2611
(985) 532-5303
(985) 532-5305
Mailing address
P O DRAWER E, MATHEWS, LA 70375
(985) 532-5303
(985) 532-5305
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/01/2024
Last updated
05/01/2024
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