Individual
KELLY BOUILLION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3233 AMBASSADOR CAFFERY PARKWAY, LAFAYETTE, LA 70506
(337) 981-9923
(337) 981-9983
Mailing address
3233 AMBASSADOR CAFFERY PARKWAY, LAFAYETTE, LA 70506
(337) 981-9923
(337) 981-9983
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4467
LA
Other
Enumeration date
03/09/2007
Last updated
07/08/2007
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