Johnny J Bouzigard, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2042 Issued in LA

Practice address

15384 W Main St
Cut Off, LA 70345-3411

Phone

(985) 632-4394

Fax

(985) 632-2894

NPI assigned

Jan 27, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1169856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1346396587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15384 W MAIN ST",
            "city": "CUT OFF",
            "state": "LA",
            "postal_code": "703453411",
            "telephone_number": "985-632-4394",
            "fax_number": "985-632-2894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15384 W MAIN ST",
            "city": "CUT OFF",
            "state": "LA",
            "postal_code": "703453411",
            "telephone_number": "985-632-4394",
            "fax_number": "985-632-2894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUZIGARD",
        "first_name": "JOHNNY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-27",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "2042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1820423",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "2042",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gary Joseph Birdsall, M.D.
• Kandice Birdsall, MOT, LOTR
• Monte M Bonneval, MD
• Clayton Bossier, N.P.
• Bryan Anthony Bouzigard, D.D.S.
• Lerica Elizabeth Breaux, RBT
• Broadlands Family Services, LLC
• Broadlands Family Transportation Services, LLC
• Sharm El' Buras, MD
• Brent Michael Cantrelle, PHARMD

• General Practice Dentistry in Cut Off, LA
• Providers in Cut Off, 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 Jul 9, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.