1508867334 NPI number — BATON ROUGE DENTAL CENTER INC

Table of content: (NPI 1508867334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508867334 NPI number — BATON ROUGE DENTAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BATON ROUGE DENTAL CENTER INC
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:
1508867334
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
679 E AIRPORT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70806-6517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-926-2195
Provider Business Mailing Address Fax Number:
225-926-2192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
679 E AIRPORT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-6517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-926-2195
Provider Business Practice Location Address Fax Number:
225-926-2192
Provider Enumeration Date:
08/02/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VIGNES
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
225-926-2195

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  4666 , 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)

  • Identifier: 1880736 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 705207 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1846660 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: F1538 . This is a "BLUE CROSS OF LA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 3147391 . This is a "BLUE CROSS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".