1417256165 NPI number — DR. DENNIS JOSEPH BOOTH D.D.S. M.SC.

Table of content: DR. DENNIS JOSEPH BOOTH D.D.S. M.SC. (NPI 1417256165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417256165 NPI number — DR. DENNIS JOSEPH BOOTH D.D.S. M.SC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOOTH
Provider First Name:
DENNIS
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S. M.SC.
Provider Gender Code:
M

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:
1417256165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4420 CONLIN ST
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70006-2167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-454-6555
Provider Business Mailing Address Fax Number:
504-454-6555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4420 CONLIN ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006-2167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-454-6555
Provider Business Practice Location Address Fax Number:
504-454-6555
Provider Enumeration Date:
03/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  2191 , 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: 537804 . This is a "OCUPATIONAL LICENSE TAX" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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