Provider Demographics
NPI:1871602581
Name:BOUDREAUX, JOHN NEAL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NEAL
Last Name:BOUDREAUX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HAIFLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538
Mailing Address - Country:US
Mailing Address - Phone:337-828-1517
Mailing Address - Fax:337-828-5916
Practice Address - Street 1:600 HAIFLEIGH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538
Practice Address - Country:US
Practice Address - Phone:337-828-1517
Practice Address - Fax:337-828-5916
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA37601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1837601Medicaid