Organization
BUMGARDNER FAMILY DENTAL, APDC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN JOSEPH BUMGARDNER D.D.S. (PRESIDENT OF BUMGARDNER FAMILY DEN)
(337) 896-3062
Entity
Organization
Contact information
Practice address
4306 N. UNIVERSITY, CARENCRO, LA 70520
(337) 896-3062
Mailing address
4306 N. UNIVERSITY, CARENCRO, LA 70520
(337) 896-3062
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1860794
—
LA
Enumeration date
04/11/2019
Last updated
04/11/2019
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