Organization
DARRELL P. BOURG JR. DDS
Active
Other names
Louisiana Dental Spa
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARRELL PAUL BOURG JR. DDS (DENTIST)
(504) 340-9696
Entity
Organization
Contact information
Practice address
2521 AMES BLVD STE C, MARRERO, LA 70072-5154
(504) 340-9696
(504) 340-7207
Mailing address
21 SAN CARLOS AVE, JEFFERSON, LA 70121-2240
(504) 621-6338
(504) 340-7207
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5747
LA
Other
Enumeration date
12/20/2006
Last updated
08/22/2020
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