Provider Demographics
NPI:1023674777
Name:AFFORDABLE SMILES OF GRETNA, LLC
Entity type:Organization
Organization Name:AFFORDABLE SMILES OF GRETNA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:COATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-609-2599
Mailing Address - Street 1:400 LAPALCO BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7372
Mailing Address - Country:US
Mailing Address - Phone:504-370-9220
Mailing Address - Fax:504-507-8880
Practice Address - Street 1:400 LAPALCO BLVD STE B
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7372
Practice Address - Country:US
Practice Address - Phone:504-370-9220
Practice Address - Fax:504-507-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty