Individual
LANDON DALE BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
16606 GREENWELL SPRINGS RD, GREENWELL SPRINGS, LA 70739-4128
(225) 262-4150
Mailing address
24615 MORRIS RD, PRIDE, LA 70770-9829
(225) 505-5960
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7299
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/05/2022
Last updated
05/23/2022
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