Landon Dale Broussard, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

7299 Issued in LA

Practice address

16606 Greenwell Springs Rd
Greenwell Springs, LA 70739-4128

Phone

(225) 262-4150

NPI assigned

Mar 5, 2022

Last updated

May 23, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Exceptional Dental of Central, LLC

  • General Practice Dentistry
  • Greenwell Springs, LA
  • NPI 1588482236
  NPD
• John T Roshto DDS LLC

  dba Central Oaks Dental Care

  • Dentist
  • Greenwell Springs, LA
  • NPI 1659933240
  NPD (past)

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

{
    "created_epoch": "1646438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653264000000",
    "number": "1962159368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24615 MORRIS RD",
            "city": "PRIDE",
            "state": "LA",
            "postal_code": "707709829",
            "telephone_number": "225-505-5960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16606 GREENWELL SPRINGS RD",
            "city": "GREENWELL SPRINGS",
            "state": "LA",
            "postal_code": "707394128",
            "telephone_number": "225-262-4150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "LANDON",
        "middle_name": "DALE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-05",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "LA",
            "license": "7299",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob David Breaux
• Hannah Cowart Breckwoldt, MD
• Gregory Allen Brooks Sr.
• Kelekia Michelle Brooks
• Terrence Brooks
• Domonique Nicole Brown
• Tatiyana R Brown, LPC
• Kaitlyn Campbell
• Lisa Catherine Carroll, MBA, LAT, ATC
• Shantae Cavalier

• Dentist in Greenwell Springs, LA
• Providers in Greenwell Springs, LA by specialty
• Dentist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; 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.