Individual
DR. ANDREW JOSEPH BROUILLETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6150 LINE AVE, SHREVEPORT, LA 71106-2051
(318) 868-5726
Mailing address
4956 OLD OAK DR, BENTON, LA 71006-9366
(318) 458-0478
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6843
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008580874
DRIVER'S LICENSE
LA
Enumeration date
03/28/2018
Last updated
07/29/2024
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