NPI: 1275061079 · THIBODAUX, LA 70301 · General Practice Dentistry · NPI assigned 05/24/2017
| Authorized Official | BRAUD, ELLIS (PRESIDENT) |
| NPI Enumeration Date | 05/24/2017 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 12 | $385.22 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 12 | 12 | $385.22 |