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7225 Jefferson Hwy Baton Rouge LA 70806 | |
| (225) 923-3223 | |
| (225) 923-3511 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 7225 Jefferson Hwy, Baton Rouge, Louisiana |
| Authorized Official Name and Position | Baker K Vinci (OWNER) |
| Authorized Official Contact | 2259233223 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7225 Jefferson Hwy Baton Rouge LA 70806 Ph: (225) 923-3223 | 7225 Jefferson Hwy Baton Rouge LA 70806 Ph: (225) 923-3223 |
| NPI Number | 1659401966 |
|---|---|
| Provider Enumeration Date | 03/06/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5496815441 |
|---|---|
| Medicare Enrollment ID | O20081120000186 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659401966 | NPI | - | NPPES |
| 1847429 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | LA4742 (Louisiana) | Primary |
| Provider Name | Baker K Vinci |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1194909705 PECOS PAC ID: 5597825547 Enrollment ID: I20081120000179 |
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