Organization
CHARLIE P. ILAWAN, DDS, APDC
Active
Other names
Family Dentistry of Bogalusa
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLIE P ILAWAN D.D.S. (OWNER)
(985) 735-7372
Entity
Organization
Contact information
Practice address
400 LOUISIANA AVE, BOGALUSA, LA 70427-3323
(985) 735-7372
(985) 732-5944
Mailing address
400 LOUISIANA AVE, BOGALUSA, LA 70427-3323
(985) 735-7372
(985) 732-5944
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4361
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014606
—
MS
05
—
1880949
—
LA
01
—
971021
UNITED CONCORDIA
LA
Enumeration date
05/10/2007
Last updated
11/04/2008
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