Provider Demographics
NPI:1174612998
Name:ARDOIN, CHARLES JAMES II (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JAMES
Last Name:ARDOIN
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4985 HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70665-7571
Mailing Address - Country:US
Mailing Address - Phone:337-583-2756
Mailing Address - Fax:337-583-9031
Practice Address - Street 1:4985 HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70665-7571
Practice Address - Country:US
Practice Address - Phone:337-583-2756
Practice Address - Fax:337-583-9031
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1840416Medicaid