Active NPI
Andrew Joseph Brouillette, DDS
- General Practice Dentistry
- Shreveport, LA
National Provider Identifier
1972008332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6843
- Practice address
- 6150 Line Ave
Shreveport, LA 71106-2051 - Phone
- (318) 868-5726
- NPI assigned
- Mar 28, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6843 | LA | Primary |
Addresses
Primary practice location
6150 Line Ave
Shreveport, LA 71106-2051
Mailing address
4956 Old Oak Dr
Benton, LA 71006-9366
Phone (318) 458-0478
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008580874 | Other | LA | DRIVER'S LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6843 | LA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722211200000",
"number": "1972008332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4956 OLD OAK DR",
"city": "BENTON",
"state": "LA",
"postal_code": "710069366",
"telephone_number": "318-458-0478"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6150 LINE AVE",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711062051",
"telephone_number": "318-868-5726"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUILLETTE",
"first_name": "ANDREW",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-03-28",
"last_updated": "2024-07-29",
"certification_date": "2024-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "LA",
"license": "6843",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVER'S LICENSE",
"identifier": "008580874",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.