Provider Demographics
NPI:1518714211
Name:LA VIE DENTAL LLC
Entity type:Organization
Organization Name:LA VIE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WAGUESPACK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-532-5303
Mailing Address - Street 1:P O DRAWER E
Mailing Address - Street 2:
Mailing Address - City:MATHEWS
Mailing Address - State:LA
Mailing Address - Zip Code:70375
Mailing Address - Country:US
Mailing Address - Phone:985-532-5303
Mailing Address - Fax:985-532-5305
Practice Address - Street 1:109 JOHNNY DUFRENE DR
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2611
Practice Address - Country:US
Practice Address - Phone:985-532-5303
Practice Address - Fax:985-532-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty