Michael Joseph Boudreaux, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5906 Issued in LA

Practice address

809 W Tunnel Blvd
Houma, LA 70360-5555

Phone

(985) 851-1717

Fax

(985) 851-7183

NPI assigned

Jun 25, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dentist

Education

Louisiana State University School of Dentistry, 2008

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Teche Action Board Inc

  • Federally Qualified Health Center (FQHC)
  • Franklin, LA
  • NPI 1174579262
  Medicare reassignment
• Dr. Michael Boudreaux DDS LLC

  • Dental Clinic/Center
  • Houma, LA
  • NPI 1336929595
  NPD

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

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696377600000",
    "number": "1154583714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "761 W TUNNEL BLVD",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703605545",
            "telephone_number": "985-876-5430",
            "fax_number": "985-876-0455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 W TUNNEL BLVD",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703605555",
            "telephone_number": "985-851-1717",
            "fax_number": "985-851-7183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAUX",
        "first_name": "MICHAEL",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-25",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "5906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1859061",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beth Marie Boudreaux
• Camille Cancienne Boudreaux, RPH
• Karen T Boudreaux, MAPC, LPC
• Kent Michael Boudreaux, DC
• Lorna Harrall Boudreaux, MS L-SLP
• Sharon Boudreaux
• Stephanie Hebert Boudreaux, PMHNP
• John William Bour, CRNA
• Geraldine R Bourdeaux, LPC
• Hannah Bourg, AA

• General Practice Dentistry in Houma, LA
• Providers in Houma, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.