Organization
RAYFUS J BROUSSARD, DDS INC
Active
Organization
RAYFUS J BROUSSARD, DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYFUS J BROUSSARD D.D.S. (ORTHODONTIST)
(409) 898-7847
Entity
Organization
Contact information
Practice address
1120 LONGFELLOW DR, BEAUMONT, TX 77706-4845
(409) 898-7847
Mailing address
1120 LONGFELLOW DR, BEAUMONT, TX 77706-4845
(409) 898-7847
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
11407
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164122701
—
TX
Enumeration date
01/25/2012
Last updated
01/25/2012
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