Provider Demographics
NPI:1205988524
Name:LABORDEAUX, HERBERT WILLIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:WILLIAM
Last Name:LABORDEAUX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9916 VIEUX CARRE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3211
Mailing Address - Country:US
Mailing Address - Phone:502-741-6027
Mailing Address - Fax:
Practice Address - Street 1:4516 CANE RUN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-3422
Practice Address - Country:US
Practice Address - Phone:502-448-1003
Practice Address - Fax:502-371-8161
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6006830100Medicaid