Provider Demographics
NPI:1386703544
Name:BOOTY, BILLY FREDERICK JR (DDS)
Entity type:Individual
Prefix:MR
First Name:BILLY
Middle Name:FREDERICK
Last Name:BOOTY
Suffix:JR
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 1:1962 O' NEAL LANE
Mailing Address - Street 2:#A & B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816
Mailing Address - Country:US
Mailing Address - Phone:225-753-5303
Mailing Address - Fax:225-753-3921
Practice Address - Street 1:1962 O' NEAL LANE
Practice Address - Street 2:#A & B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816
Practice Address - Country:US
Practice Address - Phone:225-753-5303
Practice Address - Fax:225-753-3921
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5311122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist