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NPI Profile for Dr CARLY R BOUDREAUX in WASHINGTON, MO.
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Pediatric Dentistry |
1223P0221X | |||
Student in an Organized Health Care Education/Training Program |
390200000X |
| NPI Number | 1326604497 |
|
| Status | Active | |
| Credentials | DMD (Doctor of Medical Dentistry) | |
| Entity | Individual | |
| Enumeration date | 05/14/2019 | |
| Last updated | 08/05/2021 - About 5 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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CARLY R BOUDREAUX
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CARLY R BOUDREAUX, DMD