Provider Demographics
NPI:1316162274
Name:TOUPS, BRENT F (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:F
Last Name:TOUPS
Suffix:
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 1:2521 MOSS ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-2129
Mailing Address - Country:US
Mailing Address - Phone:337-237-7005
Mailing Address - Fax:337-237-2056
Practice Address - Street 1:2521 MOSS ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-2129
Practice Address - Country:US
Practice Address - Phone:337-237-7005
Practice Address - Fax:337-237-2056
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3208122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1832081Medicaid