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10713 N Oak Hills Pkwy Suite B Baton Rouge LA 70810-2967 | |
| (225) 767-5343 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 10713 N Oak Hills Pkwy, Baton Rouge, Louisiana |
| Authorized Official Name and Position | Sally Bowie Daly (OWNER) |
| Authorized Official Contact | 2257675343 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 82380 Baton Rouge LA 70884-2380 Ph: (225) 767-5343 | 10713 N Oak Hills Pkwy Suite B Baton Rouge LA 70810-2967 Ph: (225) 767-5343 |
| NPI Number | 1174993661 |
|---|---|
| Provider Enumeration Date | 09/28/2015 |
| Last Update Date | 09/28/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174993661 | NPI | - | NPPES |
| 1848603 | Medicaid | LA | |
| 2959 | Other | LA | MCNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 4860 (Louisiana) | Primary |
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