Darrell P. Bourg Jr. DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5747 Issued in LA

Legal business name

DARRELL P. BOURG JR. DDS

Practice address

2521 Ames Blvd Ste C
Marrero, LA 70072-5154

Phone

(504) 340-9696

Fax

(504) 340-7207

NPI assigned

Dec 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Darrell Paul Bourg Jr., DDS

Title

Dentist

Phone

(504) 340-9696

Specialties & licenses 1

Addresses

Other names 1

• Louisiana Dental Spa Doing business as

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740344225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 SAN CARLOS AVE",
            "city": "JEFFERSON",
            "state": "LA",
            "postal_code": "701212240",
            "telephone_number": "504-621-6338",
            "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": "DARRELL P. BOURG JR. DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOURG",
        "authorized_official_first_name": "DARRELL",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "504-340-9696",
        "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": "5747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Louisiana Dental Spa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Marrero, LA
• Providers in Marrero, 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 Aug 22, 2020; 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.