NPIMap

Organization Active NPI

Exceptional Dental of Kenner

  • General Practice Dentistry
  • Kenner, LA
National Provider Identifier
1194035352
Registry record updated Dec 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
EXCEPTIONAL DENTAL OF KENNER
Practice address
1305 W Esplanade Ave
Kenner, LA 70065-2744
Phone
(504) 469-6333
Fax
(504) 469-6355
NPI assigned
Oct 20, 2010
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., DDS
Title
Dentist/Owner
Phone
(504) 469-6333

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary
Dental Clinic/Center 261QD0000X 5312 LA

Addresses

Primary practice location

1305 W Esplanade Ave
Kenner, LA 70065-2744

Mailing address

1305 W Esplanade Ave
Kenner, LA 70065-2744
Phone (504) 469-6333

National Provider Directory

National Provider Directory

Locations

1305 W Esplanade Ave
Kenner, LA 70065
Phone (504) 469-6333

NPI Registry JSON

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

{
    "created_epoch": "1287532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449532800000",
    "number": "1194035352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 W ESPLANADE AVE",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "700652744",
            "telephone_number": "504-469-6333",
            "fax_number": "504-469-6355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 W ESPLANADE AVE",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "700652744",
            "telephone_number": "504-469-6333",
            "fax_number": "504-469-6355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEPTIONAL DENTAL OF KENNER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-20",
        "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/OWNER",
        "authorized_official_telephone_number": "504-469-6333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "LA",
            "license": "5312",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenner, 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.