NPIMap

Organization Active NPI

Exceptional Dental of Marrero

  • General Practice Dentistry
  • Marrero, LA
National Provider Identifier
1134284789
Registry record updated Dec 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5312 Issued in LA
Legal business name
EXCEPTIONAL DENTAL OF MARRERO
Practice address
2521 Ames Blvd Ste C
Marrero, LA 70072-5154
Phone
(504) 340-9696
Fax
(504) 340-7207
NPI assigned
Dec 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Darrell Philip Bourg Jr., DDSNPI 1215053558
Title
Dentist
Phone
(504) 232-6624

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 5312 LA Primary

Addresses

Primary practice location

2521 Ames Blvd Ste C
Marrero, LA 70072-5154

Mailing address

2521 Ames Blvd Ste C
Marrero, LA 70072-5154
Phone (504) 340-9696

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449532800000",
    "number": "1134284789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2521 AMES BLVD STE C",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700725154",
            "telephone_number": "504-340-9696",
            "fax_number": "504-340-7207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2521 AMES BLVD STE C",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700725154",
            "telephone_number": "504-340-9696",
            "fax_number": "504-340-7207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEPTIONAL DENTAL OF MARRERO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2015-12-08",
        "status": "A",
        "authorized_official_last_name": "BOURG",
        "authorized_official_first_name": "DARRELL",
        "authorized_official_middle_name": "PHILIP",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "504-232-6624",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "5312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marrero, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.