1003245226 NPI number — DENTAL CARE GROUP

Table of content: (NPI 1003245226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003245226 NPI number — DENTAL CARE GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL CARE GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003245226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16270 AIRLINE HWY
Provider Second Line Business Mailing Address:
STE. B
Provider Business Mailing Address City Name:
PRAIRIEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70769-4589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-673-1557
Provider Business Mailing Address Fax Number:
225-673-6815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16270 AIRLINE HWY
Provider Second Line Business Practice Location Address:
STE. B
Provider Business Practice Location Address City Name:
PRAIRIEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70769-4589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-673-1557
Provider Business Practice Location Address Fax Number:
225-673-6815
Provider Enumeration Date:
11/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
JORDAN
Authorized Official First Name:
CATRINEL
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST/ OWNER
Authorized Official Telephone Number:
225-673-1557

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  6275 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com