Broussard, Jack S
Broussard, Jack S is an sole proprietor health care provider with primary practice located at 301 S Fair Oaks Ave Ste 204, Pasadena CA 91105-2536. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Broussard, Jack S can be contacted via phone (626) 796-3161.Contact Information
Primary practice address
301 S Fair Oaks Ave Ste 204
Pasadena CA 91105-2536
Phone: (626) 796-3161
Fax: (626) 796-6760
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | DN26040 | California |
Profile Details
| NPI number | 1821093832 |
|---|---|
| LBN Legal business name | Broussard, Jack S |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 16th, 2005 |
| Last updated | Oct 25th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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