Individual
MANDY FORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
14243 HIGHWAY 90, BOUTTE, LA 70039-3517
(985) 758-5110
Mailing address
14243 HIGHWAY 90, BOUTTE, LA 70039-3517
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6958
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/09/2019
Last updated
07/09/2019
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