Provider Demographics
NPI:1548314032
Name:YBOS, LOUIS IGNATIUS III (DDS)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:IGNATIUS
Last Name:YBOS
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 ROBERT BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1345
Mailing Address - Country:US
Mailing Address - Phone:985-649-7745
Mailing Address - Fax:
Practice Address - Street 1:484 ROBERT BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1345
Practice Address - Country:US
Practice Address - Phone:985-649-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA 39061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice