Basic Information
| Provider Information | |||||||||
| NPI: | 1093748972 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUBOIS | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3008 20TH ST STE H | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700024900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048341993 | ||||||||
| FaxNumber: | 5048341620 | ||||||||
| Practice Location | |||||||||
| Address1: | 5760 HAYNE BLVD | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701261252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042418457 | ||||||||
| FaxNumber: | 5042418450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 03/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 2809 | LA | Y | Dental Providers | Dentist | General Practice |
No ID Information.