Jack S Broussard in Pasadena - General Practice
Jack S Broussard - NPI 1821093832
Jack S Broussard is a General Practice in Pasadena, California. Jack S Broussard practices all healthcare services and medical treatments related to General Practice. The NPI Number for Jack S Broussard is 1821093832. The last update date is 2007-10-25.
Jack S Broussard's current location address is 301 S Fair Oaks Ave, Pasadena, California. You can contact this provider via phone number 6267963161 and fax number 6267966760. The mailing address for Jack S Broussard is 301 S Fair Oaks Ave, Pasadena, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jack S Broussard |
|---|---|
| Address | 301 S Fair Oaks Ave, Pasadena, California |
| Phone Number | 6267963161 |
| Fax Number | 6267966760 |
| Sole Proprietor | Y |
| Credentials | D.D.S. |
NPI Number Detail
| NPI Number | 1821093832 |
|---|---|
| Provider Enumeration Date | 2005-06-16 |
| Last Updated Date | 2007-10-25 |
Provider Mailing Address Detail
| Address | 301 S Fair Oaks Ave |
|---|---|
| City | Pasadena |
| State | California (CA) |
| Post Code | 9110525360 |
| Phone Number | 6267963161 |
| Fax Number | 6267966760 |
Provider's Primary Taxonomy Detail
| Speciality | General Practice |
|---|---|
| Taxonomy | 1223G0001X |
| Licence No | DN26040 |
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Definition: A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
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What is the Jack S Broussard's 1821093832?
The Jack S Broussard's NPI (National Provider Identifier) Number is 1821093832. This unique 10-digit identification number is assigned to health care providers by the Centers for Medicare & Medicaid Services (CMS).
Could you share the physical location details of Jack S Broussard?
The Jack S Broussard is situated at 301 S Fair Oaks Ave, in the city of Pasadena, state of CA, with the zip code 9110525360.
What is Jack S Broussard's specialized field of practice, and what is the corresponding taxonomy code that categorizes this area of expertise?
The area of specialization for Jack S Broussard is General Practice, and the taxonomy code that classifies this field of practice is 1223G0001X.
When did the Jack S Broussard receive its 1821093832?
The Jack S Broussard was issued its 1821093832 on 2005-06-16, which is the date when the organization was assigned this unique identifier.
As of what date were the Jack S Broussard's details last updated?
The information pertaining to the Jack S Broussard, including its address, specialty, and other details, was most recently updated on 2007-10-25.