Provider Demographics
NPI:1487294724
Name:SOUTH LOUISIANA DENTOFACIAL SENTER, L.L.C.
Entity type:Organization
Organization Name:SOUTH LOUISIANA DENTOFACIAL SENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:CUARTAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-872-3677
Mailing Address - Street 1:600 VALHI BLVD
Mailing Address - Street 2:
Mailing Address - City:HOURNA
Mailing Address - State:LA
Mailing Address - Zip Code:70360
Mailing Address - Country:US
Mailing Address - Phone:985-872-3677
Mailing Address - Fax:985-872-3680
Practice Address - Street 1:600 VALHI BLVD
Practice Address - Street 2:
Practice Address - City:HOURNA
Practice Address - State:LA
Practice Address - Zip Code:70360
Practice Address - Country:US
Practice Address - Phone:985-872-3677
Practice Address - Fax:985-872-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty