Country Club Dental
NPI #1003970682 in Baton Rouge, Louisiana
Provider Information
- NPI Number
- 1003970682
- Entity Type
- Organization
- Organization Name
- Country Club Dental
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Dec 20, 2006
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 16645 HIGHLAND RD STE J
- City
- Baton Rouge
- State
- Louisiana
- ZIP Code
- 70810-6567
- Phone
- (225) 214-0100
Authorized Official
- Name
- DR. DARRELL PAUL BOURG JR., DDS
- Title
- DENTIST
- Phone
- (504) 232-6624
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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