Christus Coushatta Dental Clinic | |
1401 Industrial Dr Coushatta LA 71019 | |
(318) 932-2100 | |
(318) 932-2010 |
Full Name | Christus Coushatta Dental Clinic |
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Speciality | Clinic/center - Dental |
Location | 1401 Industrial Dr, Coushatta, Louisiana |
Authorized Official Name and Position | Monte Wilson (CEO) |
Authorized Official Contact | 3374702100 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Christus Coushatta Dental Clinic Po Box 847329 Dallas TX 75284-7329 Ph: (800) 756-7999 | Christus Coushatta Dental Clinic 1401 Industrial Dr Coushatta LA 71019 Ph: (318) 932-2100 |
NPI Number | 1790767267 |
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Provider Enumeration Date | 11/18/2005 |
Last Update Date | 10/20/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1790767267 | NPI | - | NPPES |
1880795 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | 551RHC-1 (Louisiana) | Primary |