NPIMap

Organization Active NPI

Michael J Boudreaux DDS

  • General Practice Dentistry
  • Houma, LA
National Provider Identifier
1134493653
Registry record updated Mar 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5906 Issued in LA
Legal business name
MICHAEL J BOUDREAUX DDS
Practice address
6860 W Park Ave
Suite a
Houma, LA 70364-2623
Phone
(985) 209-9338
NPI assigned
Mar 1, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2012

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

Authorized official

Name
Dr. Michael Joseph Boudreaux, DDS
Title
Owner
Phone
(985) 209-9338

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 5906 LA Primary

Addresses

Primary practice location

6860 W Park Ave
Suite a
Houma, LA 70364-2623

Mailing address

6860 W Park Ave
Suite a
Houma, LA 70364-2623
Phone (985) 209-9338

Other names 1

  • Park Avenue Dental Doing business as

National Provider Directory

National Provider Directory

Locations

6860 W Park Ave
Ste A
Houma, LA 70364
Phone (985) 209-9338

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1330560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330560000000",
    "number": "1134493653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6860 W PARK AVE",
            "address_2": "SUITE A",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703642623",
            "telephone_number": "985-209-9338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6860 W PARK AVE",
            "address_2": "SUITE A",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703642623",
            "telephone_number": "985-209-9338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J BOUDREAUX DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-01",
        "last_updated": "2012-03-01",
        "status": "A",
        "authorized_official_last_name": "BOUDREAUX",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-209-9338",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "5906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Avenue Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Houma, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; 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.